Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke

Mary I. Dallas, Shari Rone-Adams, John L. Echternach, Lawrence M. Brass, Dawn Bravata

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67 445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]≤9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR≤2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR≤0.79; 95% CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.

Original languageEnglish
Pages (from-to)2298-2303
Number of pages6
JournalStroke
Volume39
Issue number8
DOIs
StatePublished - Aug 1 2008

Fingerprint

Stroke
Skilled Nursing Facilities
Activities of Daily Living
Medicare
Hospital Mortality
Survivors
Therapeutics
Logistic Models
Odds Ratio

Keywords

  • Cerebrovascular accident
  • Elderly
  • Outcome assessment
  • Walking

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke. / Dallas, Mary I.; Rone-Adams, Shari; Echternach, John L.; Brass, Lawrence M.; Bravata, Dawn.

In: Stroke, Vol. 39, No. 8, 01.08.2008, p. 2298-2303.

Research output: Contribution to journalArticle

Dallas, Mary I. ; Rone-Adams, Shari ; Echternach, John L. ; Brass, Lawrence M. ; Bravata, Dawn. / Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke. In: Stroke. 2008 ; Vol. 39, No. 8. pp. 2298-2303.
@article{462927ba40a94afd916b579f2511ca90,
title = "Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke",
abstract = "BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67 445 patients hospitalized with an ischemic stroke, 6{\%} were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]≤9.9; 95{\%} CI, 9.0 to 10.8); in-hospital mortality (OR≤2.4; 95{\%} CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR≤3.5; 95{\%} CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR≤3.5; 95{\%} CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR≤0.79; 95{\%} CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.",
keywords = "Cerebrovascular accident, Elderly, Outcome assessment, Walking",
author = "Dallas, {Mary I.} and Shari Rone-Adams and Echternach, {John L.} and Brass, {Lawrence M.} and Dawn Bravata",
year = "2008",
month = "8",
day = "1",
doi = "10.1161/STROKEAHA.107.506329",
language = "English",
volume = "39",
pages = "2298--2303",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke

AU - Dallas, Mary I.

AU - Rone-Adams, Shari

AU - Echternach, John L.

AU - Brass, Lawrence M.

AU - Bravata, Dawn

PY - 2008/8/1

Y1 - 2008/8/1

N2 - BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67 445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]≤9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR≤2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR≤0.79; 95% CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.

AB - BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67 445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]≤9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR≤2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR≤3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR≤0.79; 95% CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.

KW - Cerebrovascular accident

KW - Elderly

KW - Outcome assessment

KW - Walking

UR - http://www.scopus.com/inward/record.url?scp=49849085998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49849085998&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.107.506329

DO - 10.1161/STROKEAHA.107.506329

M3 - Article

C2 - 18583564

AN - SCOPUS:49849085998

VL - 39

SP - 2298

EP - 2303

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 8

ER -