Functional recovery of older stroke patients discharged from hospital to home: The effects of cognitive status and different levels of therapy intensity

Abstract

Aims and objectives: To determine whether and how cognitive impairment interacts with therapy intensity to affect functional improvements in older stroke patients over an 8-week postdischarge intervention delivered in a community setting. Background: Cognitive status is an important predictor of success of community-based rehabilitation, but little has been known as to how cognitive impairment may affect outcomes through its interaction with the rehabilitation process. Design: A prospective follow-up evaluation was conducted in Hong Kong of older stroke patients (n = 384) who were admitted to an 8-week home-based rehabilitation intervention after discharge in Hong Kong between 2012–2014. Methods: Cognitive screening was conducted among patients at the time of discharge from hospital. The intervention process was monitored, and individuals’ therapy intensity was assessed and recorded by physical or occupational therapists independently in each therapy session. Outcomes were measured using the 10-item Barthel ADL index at discharge and after the intervention. Results: Therapy intensity significantly moderated the relationship between cognitive impairment and functional recovery. Cognitively impaired stroke patients with moderate-intensity rehabilitation reported significantly higher increase in functional performance than that of patients with low- and high-intensity rehabilitation. In patients with no cognitive impairment, those who received high-intensity treatment showed significantly more functional gains than that of patients being treated with less intensive rehabilitation. Conclusion: Cognitive impairment affected functional outcomes through its interaction with different levels of therapy intensity among poststroke older patients. Relevance to clinical practice: Increasing therapy intensity from moderate to high benefitted cognitively intact but not cognitively impaired patients. These results should inform decisions about community-based rehabilitation and be used to identify the most cost-effective service delivery model. © 2018 John Wiley & Sons Ltd