Neurobehavioral disability in stroke patients during subacute inpatient rehabilitation: prevalence and biopsychosocial associations

ABSTRACT

Background and Objectives: There are scarce data on post-stroke neurobehavioral disability (NBD). The aim of this study was to identify the prevalence of NBD in a subacute inpatient stroke population and examine potential associations with demographic, stroke-related, functional and psychosocial variables.

Methods: 82 survivors of stroke were consecutively recruited during their inpatient rehabilitation admission. Nursing staff rated NBD in patients using the St Andrews –Swansea Neurobehavioral Outcome Scale (SASNOS). Measures of patient functional independence (FIM), cognition (MoCA), and mood symptoms (HADS) were collected in addition to nursing reports of whether observed NBD negatively impacted on the patient or those around them.

Results: NBD relating to interpersonal relationships (44.4% of participants) and cognition (52.4%) were highly prevalent within the sample while NBD relating to inhibition (1.2%), aggression (3.6%), and communication (2.5%) were relatively rare. Presence of NBD was significantly associated with reduced functional independence (r_s=0.39, p < 0.01) and associated with trends in cognitive impairment (r_s=0.29, p = 0.03), increased anxiety (r_s=-0.43, p = 0.02) and depressive symptoms (r_s=-0.43, p = 0.02). Presence of NBD was significantly correlated with negative impact to the patient and those around them across all SASNOS domains (r_s range 0.42 - 0.45, all p ≤ 0.01).

Conclusions: NBD is common within a subacute stroke inpatient population, particularly interpersonal and cognitive difficulties and preliminary analyses indicate associations with reduced functional ability, cognition and mood. There is a need to provide education and support to clinicians to facilitate routine assessment and management of NBD following stroke.

Keywords:

• Behaviour
• Neurobehaviour
• Rehabilitation
• Stroke

Acknowledgments

The authors would like to thank the contributions of the following research assistants and students who assisted with data collection: Jamie Byrne, Tiffany Low, Holly McManus, Megan O’Neill and Cameron Redpath. We would also like to thank the nursing staff of North West 2 Ward at the Kington Centre, Melbourne, for completing the patient assessments and particularly Katrina Hidalgo, Nursing Unit Manager, for supporting this research. Finally, we would like to thank the stroke survivors and caregivers who participated in this research and gave so generously of their time.

Additional information

Funding

AGT was supported by a fellowship from the NHMRC; Lions John Cockayne Memorial Fellowship Trust Fund.