Dynamic interactions between impairment and activity after stroke: examining the utility of decision analysis methods.

OBJECTIVE

To examine the utility of decision analysis methods for examining the dynamic nature of impairment-activity interactions following stroke.

DESIGN

Decision analyses (Chi-squared Automatic Interaction Detector) of a prospective cohort study.

SETTING

Community and institutional settings based on the location of participants three months after stroke.

PARTICIPANTS

Individuals were recruited from consecutive admissions to a regional academic health center and were assessed three months after stroke (N= 67).

MAIN OUTCOME MEASURES

Neurological impairment was measured with the National Institutes of Health Stroke Scale (NIHSS). Mobility, self-care and instrumental activities of daily living (instrumental ADL) performance were assessed with a performance observation measure, the Performance Assessment of Self-care Skills (PASS). Decision analysis methods were used to examine interactions between neurological impairments and activity outcomes.

RESULTS

Unique neurological impairments were associated with each activity outcome (bowel and bladder urgency interacted with mobility; hand function interacted with self-care; mental functions interacted with instrumental ADL), and these findings are supported by previous studies. The predictive validity of mobility and self-care analyses was stronger than the instrumental ADL analyses.

CONCLUSIONS

Decision analysis methods show promise for understanding dynamic impairment--activity interactions. This understanding may enhance methods for informing rehabilitation decisions.