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Original research| Volume 102, ISSUE 4, P645-655, April 2021

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation

Published:January 09, 2021DOI:https://doi.org/10.1016/j.apmr.2020.11.020

      Abstract

      Objective

      To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect.

      Design

      Retrospective, longitudinal cohort study.

      Setting

      Inpatient rehabilitation unit of an urban academic medical center.

      Participants

      Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke.

      Intervention

      None.

      Main Outcome Measures

      Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as “improved,” “unchanged,” or “declined” between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS).

      Results

      For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains.

      Conclusions

      Despite group gains from DC to 6M and an apparent “plateau” after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.

      Keywords

      List of abbreviations:

      AM-PAC (Activity Measure for Post-Acute Care), BI (Barthel Index), BM (basic mobility), DA (daily activity), DC (discharge), FS (functional stage), MCID (minimal clinically important difference), MDC (minimal detectable change), MoCA (Montreal Cognitive Assessment), 6M (6 months), 12M (12 months), US (United States)
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