Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study

OBJECTIVE: To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic). DESIGN: A 12-month follow-up observational retrospective cohort study. SETTING: Staged community-based brain injury rehabilitation. PARTICIPANTS: Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team. RESULTS: After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (P<.001) and across Ability (P<.001) and Participation (P<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (P<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (P<.01) than the hemorrhagic right hemisphere group at admission. CONCLUSIONS: There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.