Abstract
Objective
To assess the effect of time to acute therapy on health-related quality of life (HRQoL)
and disability after ischemic stroke.
Design
Prospective cohort study.
Setting
Comprehensive stroke care center in a large metropolitan city.
Participants
Patients (N=553; mean age, 67 y; 51.9% male; 64.4% white; 88.8% ischemic stroke) with
ischemic stroke or transient ischemic attack (TIA) enrolled in a longitudinal observational
study between August 2012 to January 2014 who received rehabilitation services.
Intervention
Not applicable.
Main Outcome Measures
Disability status was assessed with the modified Rankin Scale (mRS) and Barthel Index
(BI). HRQoL was assessed using the Quality of Life in Neurological Disorders measures
of executive function, general cognitive concerns, upper extremity dexterity, and
lower extremity mobility. Time to therapy consult and treatment were defined as the
number of days from hospital admission to initial consult by a therapist and number
of days from hospital admission to initial treatment, respectively.
Results
Among the participants, the median number of days from hospital admission to acute
therapy consult was 2 days (interquartile range, 1-3d). Multivariable linear and logistic
regression models indicated that for those with the National Institutes of Health
Stroke Scale (NIHSS) score<5, longer time to therapy consult was associated with worse
BI scores (BI=100; odds ratio [OR], 0.818; P=.008), executive function T scores (b=–0.865; P=.001), and general cognitive concerns T scores (b=–0.609; P=.009) at 1-month in adjusted analyses. In those with NIHSS score≥5, longer time to
therapy treatment led to increased disability (ie, mRS≥ 2; OR, 1.15; P=.039) and lower extremity mobility T scores (b=–0.591; P=.046) at 1 month in adjusted analyses.
Conclusions
Longer time to initiation of acute therapy has differential effects on poststroke
disability and HRQoL up to 1-month after ischemic stroke and TIA. The effect of acute
therapy consult is more notable for those with mild deficits, while the effect of
acute therapy treatment is more notable for those with moderate to severe deficits.
Minimizing time to therapy consults and treatments in the acute hospital period might
improve outcomes after ischemic stroke and TIA.
Keywords
List of abbreviations:
BI (Barthel Index), HRQoL (health-related quality of life), ICU (intensive care unit), IQR (interquartile range), LOS (length of stay), MCID (minimal clinically important difference), mRS (modified Rankin Scale), Neuro-QoL (Quality of Life in Neurological Disorders), NIHSS (National Institutes of Health Stroke Scale), PRO (patient-reported outcome), TIA (transient ischemic attack), TOAST (Trial of Org 10172 in Acute Stroke Treatment)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 21, 2020
Footnotes
Supported by the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training, the National Research Service Award postdoctoral fellowship (grant no. F32HS024366), the Administration for Community Living’s Switzer Research Fellowship (grant no. 90SF0010), the National Institutes of Health's National Center for Advancing Translational Sciences (grant no. UL1TR000150 and UL1TR001422), and the National Research Service Award postdoctoral fellowship at the Center for Education in Health Sciences, under an institutional award from the Agency for Healthcare Research and Quality (grant no. T-32 HS 000078). A.N. reports funding from Agency for Healthcare Research and Quality (grant no. K18 HS023437) and National Institutes of Health (grant no. UL1TR001422). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders played no role in the design, conduct, or reporting of this study.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
