Post-stroke lateropulsion and rehabilitation outcomes: A retrospective analysis
Document Type
Journal Article
Publication Title
Disability and Rehabilitation
Publisher
Taylor & Francis
School
School of Medical and Health Sciences
RAS ID
36193
Funders
Charlies Foundation for Research (RAC 2019-20-019)
Department of Health
Raine Medical Research Foundation
Clinician Research Fellowship (CRF04-R9)
Australian Government
Research training Program Scholarship
Abstract
Purpose:
A person with post-stroke lateropulsion actively pushes themselves toward their hemiplegic side, or resists moving onto their non-hemiplegic side. This study aimed to determine the association of lateropulsion severity with: • Change in function (Functional Independence Measure–FIM) and lateropulsion severity (Four-Point Pusher Score–4PPS) during inpatient rehabilitation; • Inpatient rehabilitation length of stay (LOS); • Discharge destination from inpatient rehabilitation.
Methods:
Retrospective data for 1,087 participants (aged ≥ 65 years) admitted to a stroke rehabilitation unit (2005–2018) were analysed using multivariable regression models.
Results:
Complete resolution of lateropulsion was seen in 69.4 % of those with mild lateropulsion on admission (n = 160), 49.3 % of those with moderate lateropulsion (n = 142), and 18.8 % of those with severe lateropulsion (n = 181). Average FIM change was lower in those with severe lateropulsion on admission than those with no lateropulsion (p < 0.001). Higher admission 4PPS was associated with reduced FIM efficiency (p < 0.001), longer LOS (p < 0.001), (adjusted mean LOS: 35.6 days for those with severe lateropulsion versus 27.0 days for those without), and reduced likelihood of discharge home (p < 0.001).
Conclusion:
Post-stroke lateropulsion is associated with reduced functional improvement and likelihood of discharge home. However, given a longer rehabilitation duration, most stroke survivors with moderate to severe lateropulsion can achieve important functional improvement.
Implications for Rehabilitation
While people with post-stroke lateropulsion can be difficult to treat and require more resources than those without lateropulsion, the majority of those affected, even in severe cases, can make meaningful recovery with appropriate rehabilitation.
Although those with moderate to severe post-stroke lateropulsion may have poorer outcomes (longer LOS and reduced likelihood of discharge home) it is still important to advocate for access to rehabilitation for this patient group to give them the opportunity for optimal functional recovery.
DOI
10.1080/09638288.2021.1928300
Access Rights
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Comments
Nolan, J., Godecke, E., Spilsbury, K., & Singer, B. (2022). Post-stroke lateropulsion and rehabilitation outcomes: A retrospective analysis. Disability and Rehabilitation, 44(18), 5162-5170.
https://doi.org/10.1080/09638288.2021.1928300