Postural control the best predictor of stroke rehabilitation outcome

Having good postural control at admission to a skilled nursing facility (SNF) after a stroke significantly increases elderly patients' chances of achieving a successful discharge to independent living and having good functional status at discharge, study results show.

Clinicians should see this factor as the most important determinant of rehabilitation outcome in this population, suggest the researchers in Age and Ageing.

"Balance seems to play an important role in elderly stroke patients," they remark, as has been observed in previous findings.

Contrary to their hypothesis for the current study, and findings from previous studies in younger adult patients however, Monica Spruit-van Eijk (Radboud University Nijmegen, the Netherlands) and colleagues found no relationship between the presence of multimorbidities at SNF admission and rehabilitation outcome.

"Thus, it is possible that multi-morbidity has a higher predictive value in relatively young compared with elderly survivors of stroke, perhaps related to a lower prevalence in the younger population," the team remarks.

The results emerge from data for 175 participants of the Dutch Geriatric Rehabilitation in Amputation and Stroke study who were aged a median of 79 years and whose capabilities of balance, gait, activities of daily living, cognitive function, and language were assessed at admission to a SNF for poststroke rehabilitation.

Patients who were successfully discharged to independent living within a year of admission were significantly younger, at 78 versus 82 years than those who were not, had better postural control, with median scores of 38 versus 4 (of a possible 56) on the Berg Balance scale, and had better visuospatial perception, at a median 2 versus 6 (of a possible 54) on the star cancellation test of the behavioral inattention test.

Indeed, these factors explained 32% of the variance of successful discharge, note Spruit-van Eijk et al.

Having good postural control and good visuospatial perception at admission to SNF were also independently associated with Barthel Index - a measure of functional status - at discharge, accounting for 48% of total variance.

"The fact that the same set of determinants was found for 'living situation' and 'functional status' after rehabilitation supports the validity of both the independent and dependent variables," concludes the research team.

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