a Colorado College , Colorado Springs , CO , USA.
b University of Colorado Denver , Denver , CO , USA.
Clin Neuropsychol. 2019 Jul;33(5):854-872. doi: 10.1080/13854046.2018.1546905. Epub 2019 Jan 24.
Stroke is a common cause of death and adult chronic neurologic disability. Although factors such as cardiovascular disease affect the incidence of stroke, less is known about factors influencing longitudinal stroke outcomes. The purpose of this research was to assess the contribution of executive functioning (EF) at discharge to the prediction of functional status at several timepoints between discharge from a stroke rehabilitation unit and 12 months, in comparison with depression, mental status, comorbidity, and pain at discharge, and daily functioning prior to admission. The sample comprised 246 inpatients aged 65 and older who were on inpatient rehabilitation services following acute hospitalization for a stroke. Patients (or proxies) were interviewed in person at discharge about their ability to engage in activities of daily living (ADL), and by telephone at follow-ups 3, 6, 9, and 12 months after discharge. Functional outcomes included independence in bathing, dressing, walking, use of the toilet, and chair/bed transfers. Hypotheses were tested concerning the relative contribution of EF, depression, mental status, comorbidity, and several other demographic and clinical variables to ADL performance. Executive functioning, depression, and pre-admission ADL functioning were strong predictors of outcome at all five timepoints, while neither comorbidity nor mental status were retained in any regression models. Pain at discharge was a significant predictor at discharge and 6 month follow-up. Executive functioning and depression are robust predictors of functional status following stroke rehabilitation. Although not consistently a significant predictor, pain might also be a useful addition to predictive models.
中风是导致死亡和成年人慢性神经残疾的常见原因。尽管心血管疾病等因素会影响中风的发病率，但对于影响中风纵向结果的因素知之甚少。本研究的目的是评估出院时的执行功能（EF）对从中风康复病房出院后几个时间点的功能状态的预测能力，与出院时的抑郁、精神状态、合并症和疼痛以及入院前的日常功能进行比较。该样本包括 246 名 65 岁及以上的住院患者，他们在急性中风住院后接受住院康复服务。在出院时，通过亲自访谈患者（或代理人）了解他们进行日常生活活动（ADL）的能力，并在出院后 3、6、9 和 12 个月通过电话进行随访。功能结果包括独立洗澡、穿衣、行走、使用厕所和椅子/床转移。检验了 EF、抑郁、精神状态、合并症和其他一些人口统计学和临床变量对 ADL 表现的相对贡献的假设。在所有五个时间点，执行功能、抑郁和入院前的 ADL 功能都是结果的强预测因素，而合并症和精神状态都没有保留在任何回归模型中。出院时的疼痛是出院和 6 个月随访时的显著预测因素。中风康复后，执行功能和抑郁是功能状态的可靠预测因素。尽管疼痛不是一个一致的显著预测因素，但它也可能是预测模型的有用补充。
