The effect of poststroke cognitive impairment on rehabilitation process and functional outcome.
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.
Zinn
Sandra
S
Rehabilitation Research and Development, Durham Veterans Affairs Medical Center (151), 508 Fulton Street, Durham, NC 27705, USA. sandra.zinn@duke.edu
Dudley
Tara K
TK
Bosworth
Hayden B
HB
Hoenig
Helen M
HM
Duncan
Pamela W
PW
Horner
Ronnie D
RD
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