Predicting outcome after stroke: the role of aphasia

Abstract

Objective. Very few studies have investigated the predictive value of functional outcome, social outcome and discharge destination in patients with cerebrovascular accident (CVA) with aphasia. The aim of this study was to verify whether aphasia is predictor for outcome in patients with stroke with aphasia.

Methods. The study was carried out in 262 patients with primary diagnosis of CVA and aphasia, included over a 6-year period (2001–2007): 131 with and 131 without aphasia. Statistically significant variables at the univariate regression analysis were submitted to the multivariate analysis. Backward stepwise regression analysis was applied to predict final motor-Functional Independence Measure (FIM), effectiveness in motor-FIM, final cognitive-FIM score and effectiveness in cognitive-FIM and discharge destination. Independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, motor function, trunk control test, initial motor-FIM and committed caregiver identified on admission to rehabilitation.

Results. Patients with aphasia had lower motor-FIM and cognitive-FIM scores both at admission and at discharge, if compared with those without aphasia. Effectiveness in motor-FIM and cognitive-FIM scores was also poorer in patients with aphasia. Seventy-seven per cent of patients with aphasia and 91.6% of patients without aphasia returned at home. In the multivariate regression analysis, aphasia was predictor of final motor-FIM (β = 0.15), final cognitive FIM (β = 0.72), effectiveness in motor-FIM (β = 0.17) and discharge destination (β = 0.20).

Conclusions. Aphasia is a predicting factor of outcome and it is the most important predictor of social outcome in patients with stroke with aphasia.

Keywords:

• Cerebrovascular accident
• aphasia
• cognitive deficits
• rehabilitation
• stroke

Acknowledgements

The authors thank Dr. Laura Comini and Dr. Alessandro Bettini for critical revision and editing the manuscript. The study was not supported by pharmaceutical company. The study was supported by institutional funding.