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

Dallas MI, Rone-Adams S, Echternach JL, Brass LM, Bravata DM. Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke. Stroke; A Journal of Cerebral Circulation. 2008 Aug 1; 39(8):2298-303.

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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.