Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke

被引:25
|
作者
Dallas, Mary I. [1 ]
Rone-Adams, Shari [2 ,3 ]
Echternach, John L. [3 ,4 ]
Brass, Lawrence M.
Bravata, Dawn M. [1 ,5 ,6 ]
机构
[1] VA Connecticut Healthcare System, Clin Epidemiol Res Ctr, West Haven, CT 06516 USA
[2] Brunel Univ, Dept Physiotherapy, Uxbridge UB8 3PH, Middx, England
[3] Nova SE Univ, Phys Therapy Program, Ft Lauderdale, FL 33314 USA
[4] Old Dominion Univ, Norfolk, VA USA
[5] Indiana Univ, Sch Med, Ctr Excellence Implementing Evidence Based Practi, Richard L Roudebush VA Med Ctr,Dept Internal Med, Indianapolis, IN USA
[6] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA
关键词
cerebrovascular accident; walking; elderly; outcome assessment;
D O I
10.1161/STROKEAHA.107.506329
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose - Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. Methods - This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. Results - Among the 67 445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85). Conclusions - These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
引用
收藏
页码:2298 / 2303
页数:6
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