PREDICTING LENGTH OF STAY, FUNCTIONAL OUTCOME, AND AFTERCARE IN THE REHABILITATION OF STROKE PATIENTS - THE DOMINANT ROLE OF HIGHER-ORDER COGNITION

Background and Purpose: Research in recent years has revealed factors that are important predictors of physical and functional rehabilitatio n: demographic variables, visual and perceptual impairments, and psych ological and cognitive factors. However, there is a remaining uncertai nty about prediction of outcome and a need to clinically apply researc h findings. This study was designed to identify the relative importanc e of medical, functional, demographic, and cognitive factors in predic ting length of stay in rehabilitation, functional outcome, and recomme ndations for postdischarge continuation of services. Methods: The infl uence of these factors was determined by comparing diagnostic, medical , demographic, functional, and neuropsychological information that was retrospectively obtained by reviewing the records of 86 patients admi tted for comprehensive rehabilitation due to stroke (n=36) or orthoped ic injury (n=50). Multiple linear regression with statistical adjustme nt to control for overprediction of variance was used to predict outco mes. Results: The study revealed the primary importance of higher-orde r cognitive impairments (comprehension, judgment, short-term verbal me mory, and abstract thinking) in extending length of stay and increasin g referrals for outpatient therapies and home services after discharge for the cerebrovascular accident patients in comparison with orthoped ic cohorts. Conclusions: The need is discussed for early, comprehensiv e assessment of deficits in cognition that affect a stroke survivor's ability to participate in a rehabilitation program and remediation tha t facilitiates functional improvement by building on residuals of impa ired abilities or teaching compensatory behaviors.