Orientation in the acute and chronic stroke patient: impact on ADL and social activities. The Copenhagen Stroke Study.
OBJECTIVE
To determine the influence of initially lowered orientation on rehabilitation outcome in stroke patients, and how decreased orientation 6 months after stroke influences ADL and social activities.


METHODS
Prospective, consecutive, and community based.


METHODS
A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit.


METHODS
524 patients with acute stroke.


METHODS
Basic ADL assessed by the Barthel Index (BI) at discharge; discharge placement; higher level ADL and social functions assessed by the Frenchay Activity Index(FAI) at a 6-month follow-up.


RESULTS
The independent influence of orientation in acute stroke on rehabilitation outcome was analyzed with multiple linear and logistic regression models, using initial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI, age, sex, comorbidity, prior stroke, and marital status as covariates. A one-point decrease in orientation decreased BI with 9 points (coefficient b=8.66, SE(b)=1.02,p<.0001) and reduced the likelihood (1.49, 95% CI: 1.05 to 2.11) of discharge to independent living (b=.40, SE(b)=.18,p=.026). Follow-up examinations 6 month poststroke showed that decreased orientation at this point still exerted a marked, negative influence on ADL and social functions (BI: coefficient b=12.06, SE(b)=1.95,p<.0001; FAI: coefficient b=6.28, SE(b)=1.42,p<.0001).


CONCLUSIONS
The level of orientation influences basic ADL and higher level ADL and social activities in acute as well as chronic stroke. This finding suggests that rehabilitation of memory and attention might be relevant in stroke patients with impaired orientation.
Pedersen
P M
PM
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Jørgensen
H S
HS
Nakayama
H
H
Raaschou
H O
HO
Olsen
T S
TS
D000203:Activities of Daily Living; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000145:classification / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D002908:Chronic Disease; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D009949:Orientation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D012737:Sex Factors; D012917:Social Adjustment