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Predictors of physical independence at discharge after stroke rehabilitation in a Dutch population

Ten Brink, Antonia F.; Hajos, Tibor R.S.; van Bennekom, Coen; Nachtegaal, Janneke; Meulenbelt, Henk E.J.; Fleuren, Judith F.M.; Kouwenhoven, Mirjam; Luijkx, Marscha M.; Wijffels, Markus P.; Post, Marcel W.M.

International Journal of Rehabilitation Research: March 2017 - Volume 40 - Issue 1 - p 37–45
doi: 10.1097/MRR.0000000000000198
Original articles

The aim of this study was to identify predictors, available at admission, of physical independence at discharge from inpatient rehabilitation. Secondary aims were to identify predictors of functional gain and length of stay (LOS). We included 1310 adult stroke patients who were admitted for inpatient rehabilitation in five Dutch rehabilitation centres. Data on the Utrecht Scale for Evaluation of Clinical Rehabilitation at admission and discharge (physical and cognitive independence, mood, pain and fatigue), age, sex and in a subsample stroke characteristics as well were collected. A prediction model was created using random coefficient analysis. None of the stroke characteristics were independently associated with physical independence or functional gain at discharge, or LOS. Higher physical and cognitive independence scores and severe pain at admission were predictors of higher physical independence scores at discharge. Furthermore, lower physical independence scores, higher cognitive independence scores, less pain at admission and younger age predicted more functional gain. Finally, lower physical and cognitive independence scores at admission and younger age predicted longer LOS. Physical independence at admission was the most robust predictor for rehabilitation outcome in a Dutch rehabilitation setting. To a lesser extent, age, cognitive independence and pain predicted rehabilitation outcome after stroke. Treatment of cognition and pain should be taken into account during rehabilitation. Further work needs to be carried out to establish whether focusing on these factors improves outcome after rehabilitation.

aCenter of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht

bDepartment of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee

cCoronel Institute for Occupational and Environmental Health, Academic Medical Center, University of Amsterdam, Amsterdam

dUniversity of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen

eRoessingh Rehabilitation Center, Enschede

fRevant Rehabilitation Center Breda, Breda

gRijndam Rehabilitation Centre, Rotterdam, The Netherlands

Correspondence to Marcel W.M. Post, PhD, De Hoogstraat Revalidatie, Rembrandtkade 10, 3583 TM Utrecht, The Netherlands Tel: +31 302 561 346; fax: +31 30 251 1344; e-mail:

Received June 2, 2016

Accepted September 7, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.