Subacute ischemic stroke rehabilitation outcomes in working-age adults: The role of aphasia in cognitive functional independence

ABSTRACT

Background

About one-third of adult stroke patients suffer from aphasia when they are discharged from hospital. Aphasia seems to be a negative predictive factor affecting post-stroke functional recovery after rehabilitation, but this association has been scarcely addressed in previous research.

Objectives

We aim to evaluate the impact of aphasia in cognitive functional outcomes in working-age first-ever ischemic stroke adults.

Methods

Retrospective observational cohort study. One hundred and thirty ischemic (≤ 64 years old) adult stroke patients (43.07% with aphasia) admitted to a rehabilitation center between 2007 and 2019 were analyzed. Univariate and multivariate linear regressions were performed using state-of-the-art variables (stroke severity, gender, age) extending them with potential confounders (e.g. diabetes, medication for depression). The cognitive subtest (C-FIM) of the Functional Independence Measure (FIM) at discharge and C-FIM gain were the dependent variables.

Results

Patients with aphasia (PWA) had lower C-FIM scores at admission and at discharge. No significant differences were observed in relation to C-FIM gain, C-FIM efficiency, C-FIM effectiveness and length of stay (LOS).

C-FIM gain was remarkably higher though non-significant (p = .059) in PWA. Regression analysis identifies C-FIM at admission and aphasia as significant predictors of C-FIM at discharge (R² = 0.72). The same variables plus taking medication for depression predicted C-FIM gain (R² = 0.38).

Conclusions

We identified no significant differences in C-FIM outcomes (gain, efficiency and effectiveness) either in LOS between PWA and patients without aphasia, though C-FIM differences were significant at admission and discharge. Aphasia was a significant predictor of C-FIM gain and C-FIM at discharge.

KEYWORDS:

• Aphasia
• stroke
• independent living
• rehabilitation

Acknowledgments

Special thanks to Jaume Lopez Carvallo from the Research and Innovation Department of Institut Guttmann for his continuous support in data access.

Declaration of permission to publish personal information

The authors authorize this journal to publish the personal information of the authors in conjunction with the submitted journal article.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This research was partially funded by EU H2020 PRECISE4Q - Personalized Medicine by Predictive Modeling in Stroke for better Quality of Life [Grant Agreement 777107 – Research and Innovation Action].