Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis.
Keith Lohse, Marghuretta D Bland, Catherine E Lang
PMID 27109329WHAT IT FOUND
Average monthly gains in outpatient stroke rehabilitation were small: about 1.8 Berg Balance Scale points, 2 arm test points, and 0.09 m/s walking speed.
Later start and prior inpatient rehab were linked to lower admission scores. Younger, earlier starters had faster arm and walking gains.
Key findings
01The model estimated average monthly improvements of about 1.8 Berg Balance Scale points, 2 Action Research Arm Test points, and 0.09 m/s walking speed.
02Lower admission scores were associated with later start and prior inpatient rehabilitation; older age was also associated with lower admission scores for balance and walking speed.
03For arm function and walking speed, younger patients and those who started outpatient therapy sooner had faster estimated improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This was a single-site convenience sample from a clinical database, so the estimates may not apply to other facilities or to patients who did not consent. The study could not separate the effects of outpatient therapy from natural recovery, inpatient rehabilitation, or the specific interventions and frequency each patient received. Change estimates were based only on patients who had at least two evaluations; patients with one evaluation influenced starting-score estimates only. Important variables such as co-morbidities and imaging results were not available, so the models may miss factors that influence recovery. The models were used up to twelve months, but most patients had one to six months of therapy, so estimates are most reliable in that range. Inpatient status was used as a proxy for initial disability, not a direct measure of impairment.
Declared interests
No conflicts of interest were declared. The article metadata lists NIH and non-U.S. government research support.
The easy way to misread this
Do not read these monthly gains as proof that outpatient therapy caused them. The study observed usual care in one database, could not separate natural recovery from therapy, and found average changes that were small compared with many expectations of getting better.