title: A narrative review of the impact of medical comorbidities on stroke rehabilitation outcomes.
abstract: OBJECTIVE
  Medical comorbidities in stroke patients influence acute mortality, but may also affect participation of survivors in rehabilitation. There is limited research investigating the impact of comorbidities on stroke rehabilitation outcomes. The review will explore the literature on the impact of comorbidities on stroke rehabilitation outcome.
  
  
  METHODS
  The literature was searched systematically, including MEDLINE database, EMBASE and PsychINFO, combining variations of the terms stroke, rehabilitation and comorbidities. Results were limited to English language publications. Included studies had a functional outcome.
  
  
  RESULTS
  Twenty relevant articles were identified. Fifteen small prospective or large retrospective studies using global comorbidity scales produced conflicting relationships between comorbidities and rehabilitation outcomes. Five publications addressed specific comorbidities, with three studies finding negative correlation between diabetes and rehabilitation outcomes, although effects diminished with age. In general, there were discrepancies in how comorbidities were identified. Few studies specifically focused on comorbidities and/or rehabilitation outcomes.
  
  
  CONCLUSIONS
  There is conflicting evidence regarding the impact of comorbidities on stroke rehabilitation outcomes. However, the presence of more severe diabetes may be associated with worse outcomes. The role of comorbidities in stroke rehabilitation would be best clarified with a large cohort study, with precise comorbidity identification measured against rehabilitation specific outcomes. Implications for rehabilitation Benefit of rehabilitation after stroke in improving functional outcome is well-established. Many stroke patients have comorbid conditions which can impact rehabilitation participation, leading to less benefit obtained from rehabilitation. The burden of comorbid conditions may slow rehabilitation progress, which may warrant a longer duration of rehabilitation to obtain required functional gain to be discharged into the community.
authors.affiliation: a Department of Medicine, Division of Physical Medicine & Rehabilitation , University of Toronto , Toronto , Canada.
authors.forename: Alan K H
authors.initials: AKH
authors.lastname: Tam
authors.affiliation: a Department of Medicine, Division of Physical Medicine & Rehabilitation , University of Toronto , Toronto , Canada.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Bayley
mesh_terms: D015897:Comorbidity; D006801:Humans; D017063:Outcome Assessment, Health Care; D000071939:Stroke Rehabilitation
keywords: Stroke; comorbidity; functional outcomes; rehabilitation