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Clinical Predictors of Engagement in Inpatient Rehabilitation Among Stroke Survivors With Cognitive Deficits: An Exploratory Study

Published online by Cambridge University Press:  19 March 2018

Emily A. Kringle Open the ORCID record for Emily A. Kringle [Opens in a new window] ,
Lauren Terhorst ,
Meryl A. Butters  and
Elizabeth R. Skidmore
Emily A. Kringle*
Affiliation:
Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania
Lauren Terhorst
Affiliation:
Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
Meryl A. Butters
Affiliation:
Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Elizabeth R. Skidmore
Affiliation:
Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, Pennsylvania Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
*
Correspondence and reprint requests to: Emily A. Kringle, Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260. E-mail: [email protected]
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Abstract

Objectives: The purpose of this exploratory study was to identify clinical predictors that could distinguish clients’ level of engagement in inpatient rehabilitation following stroke. Methods: This is a secondary analysis of pooled data from three randomized controlled trials that examined the effects of a behavioral intervention. The sample (n=208) consisted of clients with stroke who had cognitive deficits (Quick-EXIT≥3) and were admitted to inpatient rehabilitation facilities associated with a university medical center. Individuals with pre-morbid dementia, aphasia and mood disorders were excluded. The Pittsburgh Rehabilitation Participation Scale was used to measure engagement. Clinical predictors were measured using the Functional Independence Measure, National Institutes of Health Stroke Scale, Repeatable Battery for the Assessment of Neuropsychological Status, selected subtests of the Delis-Kaplan Executive Function System, Patient Health Questionnaire-9, and Chedoke McMaster Stroke Assessment. Simple logistic regression identified individual clinical predictors associated with engagement. Hierarchical logistic regression identified the strongest predictors of engagement. Results: Impairments in executive functions [mean D-KEFS, odds ratio (OR)=4.062; 95% confidence interval (CI)=.866, 19.051], impairments in visuospatial skills (RBANS Visuospatial Index Score, OR=3.940; 95% CI=1.317, 11.785), impairments in mood (Patient Health Questionnaire-9, OR=2.059, 95% CI=.953, 4.449), and male gender (OR=2.474; 95% CI=1.145, 5.374) predicted levels of engagement in inpatient rehabilitation after controlling for study intervention group, baseline stroke severity, and baseline disability. Conclusions: Executive functions, visuospatial skills, mood, and gender distinguished individuals with high or low engagement in inpatient rehabilitation following stroke. Further studies should examine additional factors that may influence engagement (therapist-client relationship, treatment expectancy). (JINS, 2018, 24, 572–583)

Keywords

Patient participationStrokeNeurological rehabilitationStroke rehabilitationOccupational therapyPhysical therapy
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 24 , Issue 6 , July 2018 , pp. 572 - 583
Copyright
Copyright © The International Neuropsychological Society 2018 

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