Functioning and recovery during stroke rehabilitation: a comparison between pre-stroke frail and non-frail patients

European Geriatric Medicine, vol. 14, pp. 1343–1351

Abstract

PURPOSE: Pre-stroke frailty in older adults is associated with adverse outcomes after stroke in community-based and hospital-based populations. The aim of our study was to investigate the prevalence of pre-stroke frailty among older stroke survivors receiving medical specialistic rehabilitation and its association with outcomes and recovery. METHODS: Pre-stroke frailty was measured by the Groningen Frailty Indicator (GFI, score ≥ 4 indicates frailty) in patients ≥ 65 years receiving stroke medical specialistic rehabilitation. Baseline, follow-up and change (i.e. recovery) scores of the Barthel index (BI), Stroke Impact Scale (SIS) 'mobility', 'communication', and 'memory and thinking', Hospital Anxiety and Depression Scale (HADS) and the EuroQoL-5 dimensions (EQ-5D) were compared between frail and non-frail patients with a multivariable regression model adjusting for confounders. RESULTS: Of 322 included patients (34.2% females, median age 70 years), 43 (13.4%) patients reported pre-stroke frailty. There were no differences in BI or in destination of discharge between pre-stroke frail and non-frail stroke survivors receiving inpatient rehabilitation. However, pre-stroke frailty was associated with worse follow-up scores for all other measures. Recovery in pre-stroke frail patients was less favorable compared to non-frail patients for SIS mobility, HADS subscales and EQ-5D index and visual analogue scale. CONCLUSION: Pre-stroke frailty was present in a minority of older stroke survivors receiving medical specialistic rehabilitation. BI and destination of discharge did not differ. Nevertheless, pre-stroke frailty was associated with worse functioning at follow-up for most measures of health status and with smaller improvements in mobility, mood and quality of life.

Authors 4

1. Åsa Mennema corresponding Aachen Department of Orthopaedics, Rehabilitation and Physical Therapy

   Leiden University Medical Center

   Affiliation as printed

   Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands. a.mennema@basaltrevalidatie.nl

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands. a.mennema@basaltrevalidatie.nl

   Basalt, Leiden, The Hague, The Netherlands

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

2. T. P. M. Vliet Vlieland Aachen Department of Orthopaedics, Rehabilitation and Physical Therapy

   Leiden University Medical Center

   Affiliation as printed

   Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

   Basalt, Leiden, The Hague, The Netherlands

3. Wilco P. Achterberg Aachen Department of Primary Care and Public Health

   Leiden University Medical Center

   Affiliation as printed

   Department of Primary Care and Public Health, Leiden University Medical Center, Leiden, The Netherlands

4. Daniëlla M. Oosterveer Aachen Department of Orthopaedics, Rehabilitation and Physical Therapy Department of Rehabilitation, Alrijne Hospital

   Leiden University Medical Center · Alrijne Ziekenhuis

   Affiliation as printed

   Basalt, Wassenaarseweg 501, 2333 AL, Leiden, The Hague, The Netherlands

   Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands

   Department of Rehabilitation, Alrijne Hospital, Leiden, The Netherlands

   Basalt, Leiden, The Hague, The Netherlands