Psychological correlates of outcome following rehabilitation from stroke

Objectives: To confirm, in a new sample, the value of our previously descri bed procedure for identifying abnormal illness behaviour (AIB) in stroke re habilitation patients, and to examine the relative effects of AIB, depressi on, family functioning, knowledge of stroke, and expectations of rehabilita tion on long-term rehabilitation outcome. Design: A longitudinal design, with assessments on admission to and dischar ge from rehabilitation, and six and twelve months after discharge. Setting: The study was undertaken in the rehabilitation unit at Repatriatio n General Hospital, in Adelaide, South Australia. Subjects: Sixty twelve-month stroke survivors, residing in a family environ ment, who had undergone an inpatient rehabilitation programme. Main outcome measures: AIB was assessed using the Illness Behaviour Questio nnaire, depression with the Zung Self-Rating Depression Scale, family funct ioning with the McMaster Family Assessment Device, stroke knowledge with th e Stroke Care Information Test, and expectations of rehabilitation with an open-ended question. Functional outcome was assessed with the competence an d performance assessments of the Australian ADL Index, and lifestyle activi ties with the Frenchay Activities Index. Results: Using our previously derived AIB classification rule, AIB cases sc ored poorly on functional, social and psychological indicators. Further, cl uster analysis of discharge data replicated the rule for identifying patien ts with AIB. AIB was a strong predictor of functional competence and perfor mance at rehabilitation discharge and both six and twelve months later, whi le depression was associated with an inactive lifestyle at both six and twe lve months. Greater stroke knowledge and clearer expectations of rehabilita tion were associated with better functional outcome at discharge. Family fu nctioning was strongly associated with lifestyle activities and ADL perform ance at both six and twelve months. Conclusions: The procedure for identifying AIB in this rehabilitation envir onment appears to be robust. AIB was a key determinant of long-term.