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Impact of a Stroke Recovery Program Integrating Modified Cardiac Rehabilitation on All-cause Mortality, Cardiovascular Performance and Functional Performance

Cuccurullo, Sara J. MD1; Fleming, Talya K. MD1; Kostis, William J. PhD, MD2; Greiss, Christine DO1; Gizzi, Martin S. MD, PhD3; Eckert, Anne AuD, MBA, CCC/A1; Ray, Arlen Razon PT1; Scarpati, Rosann RN1; Cosgrove, Nora M. RN, CCRC2; Beavers, Traymon BS2; Cabrera, Javier PhD2; Sargsyan, Davit MS2; Kostis, John B. MD, DPhil2

American Journal of Physical Medicine & Rehabilitation: May 3, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001214
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Objective Using a feasibility analysis and matched subgroup analysis, this study investigated the implementation/safety/outcomes of a Stroke Recovery Program(SRP) integrating modified cardiac rehabilitation(CR) for stroke survivors.

Design This prospective cohort study of 783 stroke survivors were discharged from an inpatient rehabilitation facility to an outpatient setting; 136 SRP-participants completed a feasibility study and received the SRP including modified CR, 473 chose standard of care rehabilitation(non-participants) and a group(n=174) were excluded. The feasibility study assessed: safety/mortality/pre-post cardiovascular-performance/pre-post function/patient/staff-perspective. In addition to the feasibility study, a non-randomized subgroup analysis compared SRP-participants(n=76) to matched pairs of non-participants(n=66, with 10 non-participants used more than once) for mortality/pre-post function.

Results The feasibility study showed the SRP to have:1)excellent safety, 2)markedly low 1-year post-stroke mortality from hospital admission(1.47%) compared to national rate of 31%,1

3)improved cardiovascular-performance over 36 sessions(103% increase in Metabolic Equivalent of Tasks times minutes), 4)improved function in Activity Measure of Post-Acute Care(AM-PAC)TM domains(P<0.001), 5)positive reviews from SRP-participants/staff. Subgroup analysis showed the SRP to:1)positively impact mortality; non-participants had a 9.09 times higher hazard of mortality(P=0.039), and 2)improve function in AM-PACTM domains(P<0.001).

Conclusion Stroke survivors receiving a SRP integrating modified CR may potentially benefit from reductions in all-cause mortality, and improvements in cardiovascular-performance and function.

1JFK Johnson Rehabilitation Institute, Edison, NJ

2Cardiovascular Institute at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

3Legacy Health System, Portland, OR

Corresponding Author: Sara J. Cuccurullo, M.D., JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08818, Phone 732-321-7000 X62780; Fax 732-744-5846; Email: Sara.Cuccurullo@hackensackmeridian.org

Disclosures: This study was supported in part by a Project Grant from the NorthEast Cerebrovascular Consortium (NECC) awarded to Dr. Cuccurullo and Dr. Fleming. NuStep® cross-training bicycles were provided in-kind. The statistical analysis performed for this study has not been presented in another format.

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