title: Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke.
abstract: OBJECTIVE
  Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy.
  
  
  METHODS
  This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy.
  
  
  RESULTS
  Among the 67,445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85).
  
  
  CONCLUSIONS
  These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
authors.affiliation: Clinical Epidemiology Research Center, Physical Medicine and Rehabilitation, VA Connecticut Healthcare System, West Haven, Conn 06516, USA. mary.dallas@va.gov
authors.forename: Mary I
authors.initials: MI
authors.lastname: Dallas
authors.forename: Shari
authors.initials: S
authors.lastname: Rone-Adams
authors.forename: John L
authors.initials: JL
authors.lastname: Echternach
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Brass
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology* / Q000534:rehabilitation*; D003858:Dependency, Psychological; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009043:Motor Activity; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology*; D000071939:Stroke Rehabilitation