Original article
Cognitive and Affective Predictors of Rehabilitation Participation After Stroke

https://doi.org/10.1016/j.apmr.2009.10.026Get rights and content

Abstract

Skidmore ER, Whyte EM, Holm MB, Becker JT, Butters MA, Dew MA, Munin MC, Lenze EJ. Cognitive and affective predictors of rehabilitation participation after stroke.

Objective

To examine associations between cognitive and affective impairments and rehabilitation participation during stroke rehabilitation.

Design

Secondary analyses of stroke patients who received acetylcholinesterase inhibitors during inpatient rehabilitation.

Setting

University-affiliated inpatient rehabilitation facilities.

Participants

Patients (N=44) admitted to inpatient stroke rehabilitation with impairment in attention, memory, or executive functions.

Interventions

Secondary analysis of patients receiving inpatient stroke rehabilitation care plus random assignment to one of two acetylcholinesterase inhibitors or no drug at rehabilitation admission.

Main Outcome Measures

Correlations between measures of cognitive (Digit Span, Hopkins Verbal Learning Test, Executive Interview) and affective impairments (Hamilton Rating Scale for Depression, Apathy Evaluation Scale) and participation (Pittsburgh Rehabilitation and Participation Scale) were examined. Significant correlates of participation were examined in a linear multiple regression model.

Results

Executive functions and depressive symptoms were significant correlates of participation. After controlling for baseline disability, executive functions predicted participation, but depressive symptoms did not (F4,32=9.35; R2=.54, P<.001).

Conclusions

These findings are an important first step toward understanding potentially modifiable clinical factors that contribute to rehabilitation participation and overall functional status after rehabilitation. A better understanding of cognitive impairment and rehabilitation participation may be used to develop strategies for improving functional outcomes after stroke.

Section snippets

Methods

Data were collected as part of another study examining the effects of acetylcholinesterase inhibitors on cognitive impairment in older adults after stroke.18 Participants were recruited from 2 university-affiliated inpatient stroke rehabilitation facilities. Patients were included if they were age 60 and older, had sustained an ischemic stroke within the prior 30 days, and demonstrated impairment in at least 1 of 3 cognitive domains (attention, memory, executive functions). Cognitive impairment

Results

In the parent study, among 314 patients admitted for inpatient rehabilitation, 67 consented to this study, of which 20 were subsequently excluded in accordance with the protocol and 40 started study medication. An additional 11 subjects were recruited using the same inclusion/exclusion criteria subsequent to completion of the drug study as a control group. For the current report, we conducted analyses with the subset of 44 participants for whom rehabilitation participation data were available.

Discussion

Among patients with cognitive impairment, days since stroke onset, baseline disability, executive functions, and depressive symptoms were all correlated with rehabilitation participation. Nonetheless, only baseline disability and executive functions were independent predictors of rehabilitation participation in this sample. These findings are an important first step toward identifying potentially modifiable clinical factors that contribute to rehabilitation participation and overall functional

Conclusions

Rehabilitation participation may be associated with executive functions among adults with cognitive impairment after stroke. Further examination of the determinants and effects of rehabilitation participation may be useful for identifying ways to improve overall functional outcome after stroke.

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    Supported by the National Institutes of Health (grant nos. K12 HD055931, K23 MH067710, R01 HD055525, P30 MH071944) and unrestricted investigator-initiated grants from Johnson & Johnson and Pfizer.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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