Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis

Abstract

Objective: To examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people poststroke during the time they received outpatient therapies.

Design: Retrospective analyses of an observational cohort using hierarchical linear modeling.

Setting: Outpatient rehabilitation.

Participants: Persons poststroke (N=366).

Interventions: Usual outpatient physical and occupational therapy.

Main outcomes measures: Berg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and covariance between slopes and intercepts were modeled as random effects. Additional variables modeled as fixed effects were duration (months of outpatient therapy), time (days poststroke), age (y), and inpatient status (if the patient went to an inpatient rehabilitation facility [IRF]).

Results: A patient with average age and time started at 37 points on the BBS with a change of 1.8 points per month, at 35 points on the ARAT with a change of 2 points per month, and with a walking speed of .59m/s with a change of .09m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF.

Conclusions: Patients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all 3 domains were small.

Keywords: Rehabilitation; Stroke.

Conflict of interest statement

None

Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Predictions of the regression model B5 for the Berg Balance Scale (BBS, left), model A4 for the Action Research Arm Test (ARAT, center), model T5 for the 10m Walk Test (10m WT, right). Predicted scores are shown as a function of duration of outpatient therapy, patient age, time (as days post-stroke; DPS), and Inpatient status (the top shows predictions for patients who did not attend an inpatient rehab facility/had uncertain status, the bottom row shows predictions for patients who did attend an inpatient rehab facility). Predictions were generated for ±1 standard deviation in lnTime, which translates to approximately 21 and 300 days post-stroke, and ±1 standard deviation in Age, which translates to approximately 45 and 71 years old. UE = upper extremity.