Clinical profiles and functional outcomes in elderly stroke survivors undergoing neurorehabilitation: a retrospective cohort study

Abstract

This retrospective study characterizes clinical profiles and evolution of elderly stroke patients undergoing neurorehabilitation. Additionally, it identifies predictors of functional outcomes and hospital length of stay (LOS). For this purpose, patients aged ≥ 60 years admitted for neurorehabilitation within 6 months post-stroke, were recruited between January 2015 and August 2022. Rehabilitation profiles were identified using two-step clustering analysis, including the Modified Rankin Score (mRS), the National Institutes of Health Stroke Scale (NIHSS) and the motor and cognitive Functional Independence Measure (m-FIM and c-FIM) upon admission. FIM-effectiveness was calculated as (FIM-discharge−FIM-admission)/(maximum FIM−FIM-admission). Linear regression analyses were conducted to identify predictors of functional outcomes and LOS (days). The study enrolled 104 patients (68 male; mean age = 69.45 ± 6.5 years). Three clusters were identified: “Moderate” [NIHSS = 7.70 ± 3.21, motor-FIM = 59.42 ± 12.24, cognitive-FIM = 26.96 ± 4.69, mRS = 4 (4–4), aphasia = 41.7%, severe dysphagia = 4.2%, LOS = 45 (33.25–59) days]; “Moderate-severe” [NIHS = 10.40 ± 3.23, motor-FIM = 28.00 ± 7.74, cognitive-FIM = 25.92 ± 6.55, mRS = 4 (4–5), aphasia = 13%, severe dysphagia = 6.4%, LOS = 61 (45–92) days]; and “Severe” group [NIHS = 18.76 ± 4.19, motor-FIM = 16.12 ± 6.69, cognitive-FIM = 10.58 ± 4.14, mRS = 5 (5–5), aphasia = 60.6%, severe dysphagia = 42.4%, LOS = 71 (60.5–97.5) days]. The motor and cognitive FIM effectiveness significantly improved in the “Moderate” (m-FIM-effectiveness = 33.70 [12.16–53.54]; c-FIM-effectiveness = 33.3 [0–50.0]) and “Moderate-severe” cluster (m-FIM-effectiveness = 31.15 [10.34–46.55]; c-FIM-effectiveness = 33.3[0–63.16]) compared to the “Severe” cluster (m-FIM-effectiveness = 5.77 [0–18.77]; c-FIM-effectiveness = 4.65 [0–22.30]) (p = 0.001 and p = 0.025), whereas aphasia and dysphagia improved in all groups (p > 0.1). Severe stroke (NIHSS) (β = 0.33, p < 0.001), greater functional dependence (mRS) (β = 0.24, p = 0.013), presenting dysphagia (β = 0.30, p = 0.002), neuropathic pain (β = 0.22, p = 0.02), depression (β = 0.29, p = 0.003) or in-hospital infections (β = 0.23, p = 0.02) predicted higher LOS. Patient clustering proves valuable in identifying distinct stroke rehabilitation profiles. Low FIM on admission, severe dysphagia, in-hospital infections, and psychotropic medication use, predicted poor functional outcomes and longer hospitalization.