For post-stroke mobility, look at pre-stroke ability
Conclusions based on study in journal
When predicting, for purposes of a discharge plan, a stroke patient's post-hospital mobility needs, you should take a close look at how well the patient was getting around before the stroke, an international research group reports.
Writing for the American Medical Association's journal Stroke in June [1], the authors sought to paint a clearer picture of the relationship between pre-stroke mobility and post-stroke outcomes, a relationship that has been poorly understood, according to lead author Mary I. Dallas, PhD, of the Veterans' Health Administration (VA) Clinical Epidemiology Research Center in West Haven, CT.
The researchers analyzed data from the National Stroke Project, a retrospective cohort of Medicare beneficiaries who were hospitalized for acute ischemic stroke. They studied the adjusted association between pre-stroke mobility impairment with patient outcomes and plans for physical therapy.
Among the 67,445 patients hospitalized with an ischemic stroke whose cases were reviewed by the research group, only 6% had been dependent in their pre-stroke mobility. People with prior mobility impairment were 2.4 times more likely than those without to die while in the hospital, and 3.5 times more likely to be discharged to a skilled nursing facility. These associations were independent of age, race, gender, stroke severity, and comorbid conditions.
The authors found that pre-stroke mobility dependence was independently associated with increased odds of post-stroke mobility impairment, discharge to a skilled nursing facility, and a combination of in-hospital death or discharge to a skilled nursing facility. Pre-stroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy.
"Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events," suggests Dallas, writing for the group. "We recommend that clinicians ask patients and their caregivers about prestroke mobility at the time of hospital admission."
Reference
1. Dallas MI, Rone-Adams S, Echternach JL, et al. Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke. Stroke 2008; online ahead of publication, June 26, 2008, at http://stroke.ahajournals.org.
When predicting, for purposes of a discharge plan, a stroke patient's post-hospital mobility needs, you should take a close look at how well the patient was getting around before the stroke, an international research group reports.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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