title: Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.
abstract: Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.
authors.affiliation: Convalescence and Rehabilitation Unit, Intermediate Care Hospital "Parc Sanitari Pere Virgili", Esteve Terradas 30, Barcelona, Spain. lperez@perevirgili.catsalut.net.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. lperez@perevirgili.catsalut.net.
authors.forename: Laura Mónica
authors.identifier: http://orcid.org/0000-0003-3152-9882
authors.initials: LM
authors.lastname: Pérez
authors.affiliation: Convalescence and Rehabilitation Unit, Intermediate Care Hospital "Parc Sanitari Pere Virgili", Esteve Terradas 30, Barcelona, Spain.|Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
authors.affiliation: Institute of Aging, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Roqué
authors.affiliation: Unit of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Duarte
authors.affiliation: Catalan Healthcare Service, Government of Catalonia, Barcelona, Spain.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vallés
authors.affiliation: Convalescence and Rehabilitation Unit, Intermediate Care Hospital "Parc Sanitari Pere Virgili", Esteve Terradas 30, Barcelona, Spain.|Socio-sanitary Master Plan, Ministry of Health - Government of Catalonia, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rodó
authors.affiliation: Cerebrovascular Disease Master Plan, Ministry of Health - Government of Catalonia, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Gallofré
mesh_terms: D000368:Aged; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012047:Rehabilitation Centers; D013030:Spain; D020521:Stroke / Q000503:physiopathology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Cognitive impairment; Geriatrics; Rehabilitation; Stroke