Cognitive and Affective Predictors of Rehabilitation Participation After Stroke

Skidmore ER, Whyte EM, Holm MB, Becker JT, Butters MA, Dew MA, Munin MC, Lenze EJ. Cognitive and affective predictors of rehabilitation participation after stroke. Arch Phys Med Rehabil 2010;91:203-7. Objective: To examine associations between cognitive and affective impairments and rehabilitation participation during stroke rehabilitation. Design: Secondary analyses of stroke patients who received acetylcholinesterase inhibitors during inpatient rehabilitation. Setting: University-affiliated inpatient rehabilitation facilities. Participants: Patients (N=44) admitted to inpatient stroke rehabilitation with impairment in attention, memory, or executive functions. Interventions: Secondary analysis of patients receiving inpatient stroke rehabilitation care plus random assignment to one of two acetylcholinesterase inhibitors or no drug at rehabilitation admission. Main Outcome Measures: Correlations between measures of cognitive (Digit Span, Hopkins Verbal Learning Test, Executive Interview) and affective impairments (Hamilton Rating Scale for Depression, Apathy Evaluation Scale) and participation (Pittsburgh Rehabilitation and Participation Scale) were examined. Significant correlates of participation were examined in a linear multiple regression model. Results: Executive functions and depressive symptoms were significant correlates of participation. After controlling for baseline disability, executive functions predicted participation, but depressive symptoms did not (F-4.32=9.35; R-2=.54, P<.001). Conclusions: These findings are an important first step toward understanding potentially modifiable clinical factors that contribute to rehabilitation participation and overall functional status after rehabilitation. A better understanding of cognitive impairment and rehabilitation participation may be used to develop strategies for improving functional outcomes after stroke.