title: Predictors of functional and gait outcomes for persons poststroke undergoing home-based rehabilitation.
abstract: BACKGROUND
  The literature on the impact of home-based rehabilitation on functional outcomes for patients after stroke is limited. The purpose of this study was to describe the outcomes of home-based rehabilitation (HBR) on functional and gait performance for patients after stroke and associated factors that contribute to better outcomes after an episode of care.
  
  
  METHODS
  The nature of the study design was retrospective and the settings used were home care services. The total number of subjects receiving home care services after stroke was 213 (mean age 76.5 ± 9 years, 51% female). Treatment records for patients receiving HBR in 2010 were reviewed at the start of care and discharge. The primary outcome measure was a change in a gait speed and activities of daily living (ADL) performance between admission and discharge from home health care services. The composite score to calculate overall functional status (Outcome Information and Assessment Set-version C [OASIS-C]) was used. Mean change in ADL and gait scores and factors predictive of improvement were identified using an analysis of covariance and multivariate linear models. The main outcome measures were change in the OASIS-C composite scores and gait speed.
  
  
  RESULTS
  After adjustment for age and ADL score at the start of care, discharge from skilled nursing or long-term facilities, presence of confusion most of the times, cognitive impairment, and memory deficits were negatively associated with an improvement in functional scores (ADL). Living in congregate facilities was also negatively associated with an improvement in gait speed. The best multivariate model included age, baseline ADL composite scores, confusion status, and gait speed at the start of care, which predicted 41% of the variance in ADL score changes over the course of intervention.
  
  
  CONCLUSIONS
  Gait speed and ADL scores at the start of care had largest influence on functional and gait improvement. Type of discharge facility, confusion status, and living arrangement had effects on HBR outcomes for stroke survivors.
authors.affiliation: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia. Electronic address: Faisal.asiri@icloud.com.
authors.forename: Faisal Y
authors.initials: FY
authors.lastname: Asiri
authors.affiliation: Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Marchetti
authors.affiliation: Gentiva Health Services Inc, Atlanta, GA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ellis
authors.affiliation: Gentiva Health Services Inc, Atlanta, GA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Otis
authors.affiliation: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sparto
authors.affiliation: Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Watzlaf
authors.affiliation: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003221:Confusion / Q000209:etiology / Q000523:psychology; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: OASIS-C; Stroke rehabilitation; gait speed; home care services