Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis

Stefan Knecht, Jens Roßmüller, Michael Unrath, Klaus-Martin Stephan, Klaus Berger, Bettina Studer, Stefan Knecht, Jens Roßmüller, Michael Unrath, Klaus-Martin Stephan, Klaus Berger, Bettina Studer

Abstract

Background and objective: In current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age negatively impacts the benefit obtained from high-intensity neurorehabilitation. Our objective was to test this assumption empirically in a large sample of patients with stroke.

Methods: Functional recovery during 4 weeks of inpatient neurorehabilitation was assessed with the Barthel Index (BI) in 422 middle-aged (<65 years), 1399 old (65-80 years) and 473 very old (>80 years) patients with stroke. Overall functional recovery, recovery patterns and the relationship between therapy intensity and recovery were statistically compared between the three age groups.

Results: Overall functional recovery was statistically equivalent in middle-aged, old and very old patients (average improvement in BI total score: middle-aged: 15 points; old: 15 points; very old: 14 points). A novel item-wise logistic regression analysis (see Pedersen, Severinsen & Nielsen, 2014, Neurorehabil Neural Repair) revealed that this was true for 9 of the 10 everyday functions assessed by the BI. Furthermore, functional recovery was predicted by the amount of therapy (R=0.14; p=0.0001), and age did not moderate this relationship between therapy intensity and recovery (p=0.70).

Conclusions: Old and even very old patients with stroke benefit from specialised inpatient neurorehabilitation and high amounts of therapy in the same degree as younger patients. Contrary to current clinical practice, old age should not be a criterion against admission to a neurorehabilitation unit following acute stroke treatment.

Keywords: CLINICAL NEUROLOGY; EVIDENCE-BASED NEUROLOGY; REHABILITATION; STROKE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Sample selection process.
Figure 2
Figure 2
Average functional improvement (change in total score on Barthel Index (BI)) over 4 weeks of in-patient neurorehabilitation. Error bars represent the 95% CI.
Figure 3
Figure 3
Between-age-group OR for achieving functional independence in each of the 10 Barthel Index items, adjusted for functional status on admission and therapy hours. The graph represents the adjusted odds of old (black diamond) and very old (grey circle) patients to achieve functional independence in comparisons to the odds of middle-aged patients. A value of 1 means that the odds of the older age groups are identical to those of the middle-aged group. The prognosis for old and very old patients was comparable to the prognosis of middle-aged patients for 9 of the 10 items, and even significantly better for the item feeding. Error bars represent the 95% CI.

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Source: PubMed

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