Original Article
Study of the Recovery Patterns of Elderly Subacute Stroke Patients in an Interdisciplinary Neurorehabilitation Unit

https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.014Get rights and content

Background

This study seeks to establish the facts of the improvement over time in elderly poststroke patients.

Methods

A retrospective study was performed with regard to 106 subacute stroke patients aged older than 65 years, who were treated in an interdisciplinary neurorehabilitation unit. Three assessment points were established (on admission, 6 months post-onset, and 12 months post-onset), with the scores relative to 10 assessment scales having been collected at each point.

Results

By means of a principal component analysis, a first component was obtained, which is taken to represent a combined index of the 10 scales and to express the overall health status of the patient. An analysis of variance of this first component enabled a clear improvement trend to be identified, with this being more marked during the first 6-month period (72.7%) than the second 6-month period (27.3%).

Conclusions

The elderly stroke patients underwent an interdisciplinary rehabilitation program lasting 1 year, experimented an initial period of rapid recovery during the first 6 months followed by a less marked period of improvement. However, no stabilization period in the patients' progress was found.

Introduction

The prevalence of stroke continues to be high in western countries, despite the advances made in prevention and acute-phase care.1 Because of the aging population, this pathology is most frequent among elderly patients. Approximately 75% of strokes occur in patients older than 65 years, with incidence progressively increasing for each 10-year period from 55 years onward.2

Various studies have examined the rate of progress of patients recovering from a stroke and their response to rehabilitation.

Although a great deal is known about the neurophysiological mechanisms responsible for recovery from neurologic deficits, involving brain reorganization and the mechanism of neuroplasticity,3 a variety of functional recovery patterns have been described for patients with stroke sequelae by a range of authors.4, 5, 6, 7, 8, 9, 10, 11

Moreover, despite the great impact that strokes have on the elderly population, little research has focused on the functional recovery pattern of the elderly specifically and it is, therefore, necessary for this to be clarified.

It is also essential to be able to call on assessment tools of proved effectiveness whose psychometric properties have been successfully tested on stroke patients. At the current time, a wide variety of measurements are used in poststroke assessment. However, there is as yet no consensus regarding the most suitable assessment scale or scales, with debate continuing with regard to the advantages and drawbacks of the different options available.12, 13 Taking the foregoing into account, it seems that, to study patients' progress over time, a combined system of measurement, which enables the global assessment of the patient, is required.

Thus, this study seeks to establish the facts of the improvement over time of elderly stroke patients and, to do so, it makes use of a global assessment scale, which can enable patient progress to be evaluated more precisely.

Section snippets

Materials and Methods

A total of 106 patients were selected for participation in this study (although 37 of them stopped receiving treatment for various reasons before the study was finished), 54.7% men and 45.3% women, with 67.9% having an ischemic stroke and 32.1% a hemorrhagic stroke. The median age of the sample was 69 (most patients were between 65 and 75 years) and the median chronicity was 82 days. The mean values of the modified Barthel Index (Barthel) and Functional Independence Measure (FIM) indices were

Results

The results of the PCA, which are listed in Table 1, synthesize the information provided by the different assessment scales in the form of 2 principal components, C1 and, the second component, C2.

Table 2 displays the results of the ANOVA, including the linear and quadratic effects of typical of quantitative factors, as the assessment factor (time) is. It can be seen that the assessment factor has a high level of significance, for both its linear and quadratic components (the P values being

Discussion

Regarding the first principal component obtained from the PCA, C1, it accounts for the larger part (71.8%) of the variability of the patients and is taken to represent a combined index, summarizing the information of the 10 assessment scales and expressing the overall health status (OHS) of the patient, with a higher score corresponding to a better health status. This interpretation is supported by the similar magnitude, in terms of the absolute values, of the coefficients associated with the

Conclusions

Elderly stroke patients who undergo a multidisciplinary rehabilitation program lasting 1-year experience an initially rapid recovery period over the first 6 months followed by a less marked period of improvement. However, no evidence has been found of a plateau in the recovery of these patients during the first year of treatment. It is likely that elderly patients need a longer period of time to reach the same extent of recovery from stroke as that achieved by younger patients. Therefore, we

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