Motivation in veterans with an acute/subacute ischemic stroke did not improve cognition and functional motor recovery but reduced deaths.

BACKGROUND

The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.

AIM

This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.

DESIGN

Prospective, observational, single-center study.

SETTING

Enrollment was undertaken in an inpatient neurorehabilitation facility.

POPULATION

A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.

METHODS

Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.

RESULTS

The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).

CONCLUSIONS

A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.

CLINICAL REHABILITATION IMPACT

The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.