To validate subgroups of cognitive impairment on the Montreal Cognitive Assessment (MoCA)—defined as normal (score of 25-30), mildly impaired (score of 20-24), and moderately impaired (score less than 19)—by determining whether they differ in rehabilitation gain during inpatient stroke rehabilitation.
Observational study. Linear regression models were conducted and predictors included MoCA subgroups and relevant baseline demographic and clinical covariates. Separate models included the cognitive subscale of the FIM instrument as a predictor.
Inpatient rehabilitation facility of an urban, academic medical center.
Inpatients (N=334) with mild-moderate strokes who were administered the MoCA on admission.
Main Outcome Measures
The mean relative functional gain (mRFG) and mean relative functional efficiency (mRFE, which adjusts for length of stay) on the FIM total.
MoCA subgroups significantly predicted mRFG and mRFE after accounting for age, sex, education, stroke severity, and recurrent vs first stroke. The normal group exhibited greater mRFG and mRFE than the mildly impaired group, while the moderately impaired group had significantly worse mRFG and mRFE than the mildly impaired group. The moderately impaired group had a significantly smaller proportion of individuals who made a clinically meaningful change on the total-FIM than the mildly impaired and normal groups. MoCA subgroups better accounted for mRFG and mRFE than a standard-of-care cognitive assessment (cognitive-FIM).
Use of MoCA-defined subgroups can assist providers in predicting functional gain in survivors of stroke being treated in inpatient rehabilitation.
List of abbreviations:MCID (minimum clinically important difference), MoCA (Montreal Cognitive Assessment), mRFE (mean relative functional efficiency), mRFG (mean relative functional gain), NIHSS (National Institutes of Health Stroke Scale)
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Published online: September 10, 2019
Supported by the Peter Jay Sharp Foundation and in part by the Clinical and Translational Science Center, National Center for Advancing Translational Sciences (grant no. UL1-TR000457-06).
Clinical Trial Registration No: NCT02876783.
© 2019 by the American Congress of Rehabilitation Medicine
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- CorrectionArchives of Physical Medicine and RehabilitationVol. 101Issue 6
- PreviewThe article by Jaywant et al, Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation, published in Archives of Physical Medicine and Rehabilitation 2020;101:220-226 https://www.archives-pmr.org/article/S0003-9993(19)31059-7/fulltext , contained errors. The article found that subgroups based on scores on the MoCA were associated with mean relative FIM gain (mRFG) and mean relative FIM efficiency (mRFE) in inpatient stroke rehabilitation.