The effect of poststroke cognitive impairment on rehabilitation process and functional outcome

Zinn S, Dudley TK, Bosworth HB, Hoenig HM, Duncan PW, Horner RD. The effect of poststroke cognitive impairment on rehabilitation process and functional outcome. Arch Phys Med Rehabil 2004;85:1084-90. Objectives To determine whether cognitive impairment affects access to, or quality of, rehabilitation services, and to examine the effects of functional outcomes in stroke patients. Design Secondary analysis of prospective cohort of stroke patients followed for 6 months after stroke. Settings Eleven large-volume US Department of Veterans Affairs hospitals nationwide. Participants Stroke patients (N=272) who were candidates for rehabilitation. Interventions Not applicable. Main outcome measures Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score. Functional outcomes were performance of activities of daily living (ADLs), measured by the FonFIM, and instrumental activities of daily living (IADLs), measured by Lawton, at 6-month follow-up. Results Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients. Although most cognition-related treatment elements were similar for both groups, cognitive goals were more frequently charted in impaired patients. Controlling for baseline function and rehabilitation process, cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients; cognition did not significantly influence ADL performance. Conclusions Quality of, and access to, rehabilitative care was equivalent for patients with and without cognitive impairment. Despite a similar rehabilitation process, cognitively impaired stroke patients experienced worse recovery of IADLs.