Differences in the difficulty of subtasks comprising the toileting task among patients with subacute stroke: A cohort study

Introduction: Toileting comprises multiple subtasks, and the difficulty of each is criti-cal to determining the target and priority of intervention. The study aimed to exam-ine the difficulty of subtasks that comprise toileting upon admission and the reacquisition of skills of subtasks during hospitalization. Materials and methods: This was a single-center prospective cohort study. We enrolled 101 consecutive stroke patients (mean age: 69.3 years) admitted to subacute rehabilitation wards. The inde-pendence in each of the 24 toileting subtasks was assessed using the Toileting Tasks Assessment Form (TTAF) every two or four weeks. The number of patients who were independent upon admission, as well as those who were not independent upon admission but became independent during hospitalization, was examined in each subtask. Results: The most difficult subtask upon admission was Lock the wheelchair brakes (16.8% of patients were independent), followed by Turn while standing (before urination/defecation) (17.8%), Pull the lower garments down (18.0%), Turn while standing (after urination/defecation) (18.8%), Pull the lower garments up and adjust them (18.8%), and Maintain a standing position (before urination/defecation) (18.8%). The most difficult subtask for those who were not independent but became independent was Dispose of incontinence pad/sanitary items (19.3%), followed by Press the nurse call button (after urination/defeca-tion) (28.3%), Take the foot off the footrest and place it on the ground (28.6%), and Clean up after urination/defecation (29.0%). Conclusions: The difficult sub -tasks upon admission and those for reacquired skills were different. The most diffi-cult subtasks upon admission were main tasks, and the difficult subtasks in reacquiring skills were preparatory tasks.

Automated summary

This study aimed to assess the difficulty of toileting tasks upon admission and the reacquisition of skills during hospitalization. Results showed that the most difficult tasks upon admission were locking the wheelchair brakes, turning while standing, pulling down lower garments, turning after urination/defecation, pulling up and adjusting lower garments, and maintaining a standing position before urination/defecation. The most difficult tasks for those who became independent during hospitalization were disposing of incontinence pad/sanitary items, pressing the nurse call button after urination/defecation, taking the foot off the footrest and placing it on the ground, and cleaning up after urination/defecation.