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Subgroups Defined by the Montreal Cognitive Assessment Differ in Functional Gain During Acute Inpatient Stroke Rehabilitation

  • Abhishek Jaywant
    Correspondence
    Corresponding author Abhishek Jaywant, PhD, Weill Cornell Medicine, Department of Rehabilitation Medicine, 525 East 68th Street, Baker F-1232, New York, NY 10065.
    Affiliations
    Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York

    Department of Psychiatry, Weill Cornell Medicine, New York, New York

    NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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  • Joan Toglia
    Affiliations
    Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York

    NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York

    School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
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  • Faith M. Gunning
    Affiliations
    Department of Psychiatry, Weill Cornell Medicine, New York, New York

    NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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  • Michael W. O’Dell
    Affiliations
    Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York

    NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Published:September 10, 2019DOI:https://doi.org/10.1016/j.apmr.2019.08.474

      Abstract

      Objective

      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.

      Design

      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.

      Setting

      Inpatient rehabilitation facility of an urban, academic medical center.

      Participants

      Inpatients (N=334) with mild-moderate strokes who were administered the MoCA on admission.

      Interventions

      Not applicable.

      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.

      Results

      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).

      Conclusions

      Use of MoCA-defined subgroups can assist providers in predicting functional gain in survivors of stroke being treated in inpatient rehabilitation.

      Keywords

      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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      Linked Article

      • Correction
        Archives of Physical Medicine and RehabilitationVol. 101Issue 6
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          The 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.
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