Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study

Abstract

Objective To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic). Design A 12-month follow-up observational retrospective cohort study. Setting Staged community-based brain injury rehabilitation. Participants Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months. Intervention Not applicable. Main Outcome Measures The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team. Results After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total ( P <.001) and across Ability ( P <.001) and Participation ( P <.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech ( P <.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication ( P <.01) than the hemorrhagic right hemisphere group at admission. Conclusions There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

“…It is known that cerebrovascular accident (CVA) and a neurologic disorder are originating from the blockage or rupture of cerebral blood vessels with ischemic or hemorrhagic etiologies ( AlHarfany et al, 2020 ; Ullah et al, 2020 ). Stroke or CVA leads to death and is the third leading cause of disability worldwide ( Williams et al, 2020 ). Annually, there are 15 million reported stroke cases, with 5.8 million reported deaths globally ( Al-Senani et al, 2020 ).…”

Measurement Properties of the Mayo-Portland Adaptability Inventory (MPAI-4) and Related Measures: A Systematic Review

“…Stroke: In the two included studies in which clinicians completed the MPAI-4 it had sufficient construct validity (4/5 hypotheses met) but insufficient responsiveness for all but the participation index (6/8 hypotheses met). 42,43 However, this is not yet based on high quality evidence -small sample sizes 42 and subgroup differences impeding comparison resulted in a low quality evidence rating per COSMIN criteria.…”

Evaluating the implementation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in three rehabilitation settings in Quebec: a mixed-methods study protocol

“…There is also mounting evidence to support the clinical use of standardised outcome measures20 21 to support the improvement of individuals’ function and participation,22 23 enhance patient rehabilitation outcomes,24–26 facilitate a patient-centred approach,27 and maintain clinical excellence and commitment to evidence-informed practices 28 29. An outcome measure used for these purposes is the Mayo-Portland Adaptability Inventory-version 4 (MPAI-4) which can assess both inpatient and outpatient rehabilitation patients’ functional abilities and status 30–33. Worldwide government health authorities and organisations have incorporated the MPAI-4 as part of their recommended practices in rehabilitation care for survivors of acquired brain injury.…”