An Exploration of Central Nervous System Medication Use and Outcomes in Stroke Rehabilitation
Abstract
Conroy B, Zorowitz R, Horn SD, Ryser DK, Teraoka J, Smout RJ. An exploration of central nervous system medication use and outcomes in stroke rehabilitation.
Objective
To study associations between neurobehavioral impairments, use of neurotropic medications, and outcomes for inpatient stroke rehabilitation, controlling for a variety of confounding variables.
Design
Observational cohort study of poststroke rehabilitation.
Setting
Six inpatient rehabilitation hospitals in the United States.
Participants
Patients with moderate or severe strokes (N=919).
Interventions
Not applicable.
Main Outcome Measures
Discharge disposition, FIM score change, and rehabilitation length of stay (LOS).
Results
Neurobehavioral impairments and use of many medications, including first-generation selective serotonin reuptake inhibitors, older traditional antipsychotic medications, and anti-Parkinsonian neurostimulants, have a statistical association with poorer outcomes, whereas use of the atypical antipsychotic medications has a positive association with improvement in motor FIM scores. Counterintuitively, use of opioid analgesics is associated with a larger motor FIM score change but not an increase in LOS or reduced percentage of discharge to community. There was significant variation in use of neurotropic medications among the 6 study sites during inpatient stroke rehabilitation.
Conclusions
There are many opportunities to enhance a stroke survivor’s ability to benefit from acute inpatient stroke rehabilitation through improved understanding of associations of neurotropic medications with outcomes for different patient groups.
aStroke Recovery Program, National Rehabilitation Hospital, Washington, DC
bDepartment of Rehabilitation Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
cInternational Severity Information Systems Inc and Institute for Clinical Outcomes Research, Salt Lake City, UT
dDivision of Physical Medicine and Rehabilitation, Neuro Specialty Rehabilitation Unit, LDS Hospital, Salt Lake City, UT
eDivision of Physical Medicine and Rehabilitation, Stanford University, Palo Alto, CA
Reprint requests to Susan D. Horn, PhD, Institute for Clinical Outcomes Research, 699 E South Temple, Ste 100, Salt Lake City, UT 84102-1282
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133B990005) and the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032). The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT