Change in mobility activity in the second year after stroke in a rehabilitation population: who is at risk for decline?

OBJECTIVES

To investigate the development of mobility status during the second year after stroke in patients who had had inpatient rehabilitation, and to evaluate risk factors for mobility decline.

DESIGN

Evaluation of change in Rivermead Mobility Index (RMI) score over the second year after stroke in an inception cohort of first-ever stroke patients eligible for inpatient rehabilitation. Logistic regression techniques were used to predict decline. Independent variables were measured with standardized instruments 1 year after stroke.

SETTING

Home or institution, after discharge from rehabilitation center.

PARTICIPANTS

Patients (N=148) with single first-ever stroke (supratentorial), age more than 18 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Decline of 2 or more points on the RMI and the percentages and odds ratios (ORs) for decline.

RESULTS

The mean RMI score did not significantly change over time. Mobility declined in 12% of the patients. Mobility decline was found more often in patients with depression (25%) than without (7%), with right-sided weakness (17% vs 8%), with ischemic stroke (13% vs 8%), with aphasia (22% vs 11%), with cognitive dysfunction (17% vs 11%), with comorbidity interfering with locomotion (25% vs 12%), with poor social functioning (15% vs 10%), and with mobility disability (16% vs 8%). Statistical significance was found only for depression (OR=4.2; 95% confidence interval, 1.3-13.2).

CONCLUSIONS

Most patients maintained the level of mobility they achieved during inpatient rehabilitation over the second year after stroke. Only 12% had a decline in mobility, and depression was the only statistically significant predictor for decline.