Clinical Predictors of Engagement in Inpatient Rehabilitation Among Stroke Survivors With Cognitive Deficits: An Exploratory Study

J Int Neuropsychol Soc. 2018 Jul;24(6):572-583. doi: 10.1017/S1355617718000085. Epub 2018 Mar 19.

Abstract

Objectives: The purpose of this exploratory study was to identify clinical predictors that could distinguish clients' level of engagement in inpatient rehabilitation following stroke.

Methods: This is a secondary analysis of pooled data from three randomized controlled trials that examined the effects of a behavioral intervention. The sample (n=208) consisted of clients with stroke who had cognitive deficits (Quick-EXIT≥3) and were admitted to inpatient rehabilitation facilities associated with a university medical center. Individuals with pre-morbid dementia, aphasia and mood disorders were excluded. The Pittsburgh Rehabilitation Participation Scale was used to measure engagement. Clinical predictors were measured using the Functional Independence Measure, National Institutes of Health Stroke Scale, Repeatable Battery for the Assessment of Neuropsychological Status, selected subtests of the Delis-Kaplan Executive Function System, Patient Health Questionnaire-9, and Chedoke McMaster Stroke Assessment. Simple logistic regression identified individual clinical predictors associated with engagement. Hierarchical logistic regression identified the strongest predictors of engagement.

Results: Impairments in executive functions [mean D-KEFS, odds ratio (OR)=4.062; 95% confidence interval (CI)=.866, 19.051], impairments in visuospatial skills (RBANS Visuospatial Index Score, OR=3.940; 95% CI=1.317, 11.785), impairments in mood (Patient Health Questionnaire-9, OR=2.059, 95% CI=.953, 4.449), and male gender (OR=2.474; 95% CI=1.145, 5.374) predicted levels of engagement in inpatient rehabilitation after controlling for study intervention group, baseline stroke severity, and baseline disability.

Conclusions: Executive functions, visuospatial skills, mood, and gender distinguished individuals with high or low engagement in inpatient rehabilitation following stroke. Further studies should examine additional factors that may influence engagement (therapist-client relationship, treatment expectancy). (JINS, 2018, 24, 572-583).

Trial registration: ClinicalTrials.gov NCT02755805 NCT02766400 NCT01934621.

Keywords: Neurological rehabilitation; Occupational therapy; Patient participation; Physical therapy; Stroke; Stroke rehabilitation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Affect / physiology*
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology*
  • Cognitive Dysfunction / rehabilitation*
  • Executive Function / physiology*
  • Humans
  • Neuropsychological Tests
  • Patient Participation* / statistics & numerical data
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Sex Factors
  • Space Perception / physiology*
  • Stroke / complications
  • Stroke / physiopathology
  • Stroke / therapy*
  • Stroke Rehabilitation* / statistics & numerical data
  • Survivors
  • Visual Perception / physiology*

Associated data

  • ClinicalTrials.gov/NCT02755805
  • ClinicalTrials.gov/NCT02766400
  • ClinicalTrials.gov/NCT01934621