Cognitive Impairments and Health System Outcomes in Inpatient Rehabilitation: A Comparison of Patients With Stroke and Those With Type II Diabetes Mellitus.
Jessica Edelstein, Bethany Rajaratnam, Audrey Rozell and 3 others
In inpatient rehab, whether a patient had stroke or diabetes did not predict their functional outcomes or readmission.
What did predict them was how well they could function when they arrived and how many medical problems they carried.
Key findings
1Diagnosis (stroke versus type 2 diabetes) was not a significant predictor of self-care at discharge, mobility at discharge, within-stay readmission, or 30-day readmission in adjusted regression models.
2Higher self-care and MoCA scores at admission predicted better self-care at discharge; higher mobility at admission and fewer ICD-10 diagnosis codes predicted better mobility at discharge. Male gender was associated with higher odds of within-stay readmission.
3Stroke patients scored lower on the MoCA at admission (17.52 versus 19.94) and discharge (18.02 versus 20.18), but the roughly 2-point gap does not meet the MoCA's minimal detectable change of 5.1 points, so the authors caution it may reflect scoring variability rather than a true cognitive difference.
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What it does not show
Single health system, retrospective EMR data; the authors note this limits generalizability and may introduce data accuracy issues. The diabetes group was heterogeneous in admitting diagnosis (debility, orthopedic, amputation, cardiac, among others), so it is not a uniform 'diabetes' population and the comparison with stroke is not apples-to-apples. No data on diabetes control status (controlled versus uncontrolled, with or without complications) or stroke lesion location, both of which are known to affect cognitive outcomes. The roughly 2-point MoCA difference between groups falls below the minimal detectable change of 5.1 points, so it may reflect measurement variability rather than a true cognitive difference. Only readmissions within the same hospital system were captured; readmissions to other systems were invisible to the analysis. Cross-sectional design with retrospective data; no causal inference is possible.
The easy way to misread this
Do not read the 2-point MoCA gap between the stroke and diabetes groups as a meaningful cognitive difference. The authors note it falls below the MoCA's minimal detectable change of 5.1 points, and the diabetes group included amputees, cardiac patients, and orthopedic cases rather than a uniform diabetes population.
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