title: The effect of poststroke cognitive impairment on rehabilitation process and functional outcome.
abstract: OBJECTIVE
  To determine whether cognitive impairment affects access to, or quality of, rehabilitation services, and to examine the effects of functional outcomes in stroke patients.
  
  
  METHODS
  Secondary analysis of prospective cohort of stroke patients followed for 6 months after stroke.
  
  
  METHODS
  Eleven large-volume US Department of Veterans Affairs hospitals nationwide.
  
  
  METHODS
  Stroke patients (N=272) who were candidates for rehabilitation.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score. Functional outcomes were performance of activities of daily living (ADLs), measured by the FonFIM, and instrumental activities of daily living (IADLs), measured by Lawton, at 6-month follow-up.
  
  
  RESULTS
  Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients. Although most cognition-related treatment elements were similar for both groups, cognitive goals were more frequently charted in impaired patients. Controlling for baseline function and rehabilitation process, cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients; cognition did not significantly influence ADL performance.
  
  
  CONCLUSIONS
  Quality of, and access to, rehabilitative care was equivalent for patients with and without cognitive impairment. Despite a similar rehabilitation process, cognitively impaired stroke patients experienced worse recovery of IADLs.
authors.affiliation: Rehabilitation Research and Development, Durham Veterans Affairs Medical Center (151), 508 Fulton Street, Durham, NC 27705, USA. sandra.zinn@duke.edu
authors.forename: Sandra
authors.initials: S
authors.lastname: Zinn
authors.forename: Tara K
authors.initials: TK
authors.lastname: Dudley
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Helen M
authors.initials: HM
authors.lastname: Hoenig
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
authors.forename: Ronnie D
authors.initials: RD
authors.lastname: Horner
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome