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Prognosis of Individual-Level Mobility and Daily Activities Recovery from Acute Care to Community, Part 2: A Proof-of-Concept Single Group Prospective Cohort Study

  • Allan J. Kozlowski
    Correspondence
    Corresponding Author: Allan J. Kozlowski, PhD, 1024 Sherman Street SE, Grand Rapids, MI 49506,
    Affiliations
    Department of Epidemiology and Biostatistics, Michigan State University – College of Human Medicine

    John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital

    Division of Rehabilitation, Michigan State University – College of Human Medicine
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  • Cally Gooch
    Affiliations
    John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital

    Department of Biostatistics, Grand Valley State University
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  • Mathew J. Reeves
    Affiliations
    Department of Epidemiology and Biostatistics, Michigan State University – College of Human Medicine
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  • John F. Butzer
    Affiliations
    John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital

    Division of Rehabilitation, Michigan State University – College of Human Medicine
    Search for articles by this author
Published:December 31, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.980

      Abstract

      Objective

      To demonstrate a proof-of-concept for prognostic models of post-stroke recovery on activity level outcomes.

      Design

      Longitudinal cohort with repeated measures from acute care, inpatient rehabilitation, and post-discharge follow-up to 6 months post-stroke.

      Setting

      Enrollment from a single Midwest USA inpatient rehabilitation facility with community follow-up.

      Participants

      115 persons recovering from stroke admitted to an acute rehabilitation facility

      Interventions

      Not applicable

      Main Outcome Measure(s)

      Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility and Daily Activities domains administered as 6 Clicks and patient-reported short forms.

      Results

      The final Basic Mobility model defined a group-averaged trajectory rising from a baseline (pseudo-intercept) T-score of 35.5 (p<.001) to a plateau (asymptote) T-score of 56.4 points (p<.001) at a negative exponential rate of -1.49 (p<.001). Individual baseline scores varied by age, acute care tissue plasminogen activator, and acute care length of stay. Individual plateau scores varied by walking speed, acute care tissue plasminogen activator, and lower extremity Motricity Index scores. The final Daily Activities model defined a group-averaged trajectory rising from a baseline T-score of 24.5 (p<.001) to a plateau T-score of 41.3 points (p<.001) at a negative exponential rate of -1.75 (p<.001). Individual baseline scores varied by acute care length of stay, and plateau scores varied by self-care, upper extremity Motricity Index, and Berg Balance Scale scores.

      Conclusions

      As a proof-of-concept, individual activity-level recovery can be predicted as patient-level trajectories generated from EMR data, but models require attention to completeness and accuracy of data elements collected on a fully representative patient sample.

      Keywords

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