What factors have been reported to influence ADL at discharge in stroke patients undergoing rehabili
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Factors Influencing Activities of Daily Living (ADL) at Discharge in Stroke Patients Undergoing Rehabilitation
Introduction
Stroke rehabilitation aims to improve the functional independence of patients, particularly in activities of daily living (ADL). Understanding the factors that influence ADL outcomes at discharge can help optimize rehabilitation strategies and improve patient care.
Age and Vascular Risk Factors
Age is a significant factor influencing ADL outcomes at discharge. Older stroke patients are more likely to experience deterioration in ADL performance . Additionally, having more than three vascular risk factors significantly increases the likelihood of ADL deterioration.
Depression and Cognitive Function
Post-stroke depression (PSD) is another critical factor that negatively impacts ADL outcomes. Patients with PSD are more likely to experience a decline in their ability to perform daily activities . Cognitive function, including executive functioning, also plays a crucial role. Better cognitive function at discharge is associated with improved ADL performance .
Physical Function and Balance
Physical function, particularly balance and gait ability, strongly correlates with ADL outcomes. Higher scores on the Berg Balance Scale (BBS) at discharge are protective against ADL deterioration . Muscle strength, especially in the non-hemiplegic side, and trunk control are also significant predictors of ADL independence .
Rehabilitation Intensity and Team Models
The organization and intensity of rehabilitation services significantly impact ADL outcomes. Multidisciplinary team models and concentrated hours of therapy are associated with better ADL improvements. Early supported discharge and continued home-based rehabilitation also show long-term benefits in ADL performance.
Baseline Functional Status
Baseline ADL function is a strong predictor of outcomes at discharge. Patients with higher initial ADL scores tend to maintain or improve their functional independence . Specific ADL tasks, such as grooming and dressing, are particularly predictive of overall ADL performance.
Other Factors
Additional factors influencing ADL outcomes include the severity of the stroke, measured by scales such as the National Institute of Health Stroke Scale (NIHSS), and the presence of comorbid conditions like bladder incontinence . Motivation towards rehabilitation and the ability to express intentions also play a role, particularly in older patients.
Conclusion
Multiple factors influence ADL outcomes at discharge in stroke patients undergoing rehabilitation. These include age, vascular risk factors, depression, cognitive and physical function, rehabilitation intensity, baseline functional status, and specific ADL tasks. Understanding these factors can help tailor rehabilitation programs to improve patient outcomes.
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