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Predictors of Functional Independence and Stress Level of Stroke Survivors at Discharge From Inpatient Rehabilitation

Ostwald, Sharon K. PhD, RN, FGSA; Swank, Paul R. PhD; Khan, Myrna M. PhD

The Journal of Cardiovascular Nursing: July-August 2008 - Volume 23 - Issue 4 - p 371-377
doi: 10.1097/01.JCN.0000317435.29339.5d

Background and Research Objective: Stroke is the primary cause of long-term disability among older adults. This study identifies predictors of functional independence and perceived stress for stroke survivors discharged home from inpatient rehabilitation with a spousal caregiver.

Subjects and Methods: Stroke survivors (N = 97) were interviewed immediately after discharge to obtain scores on the National Institutes of Health Stroke Scale, Functional Independence Measure (FIM), Stroke Impact Scale, Geriatric Depression Scale-15, Perceived Stress Scale, and Perceived Health Status. Demographic and stroke-related data were abstracted from their inpatient rehabilitation charts. Descriptive and regression analyses determined the relationships among variables and the models that best predicted functional independence and perceived stress.

Results: Stroke survivors perceived a 50% recovery in their function upon discharge from inpatient rehabilitation. National Institutes of Health Stroke Scale, age, socioeconomic status, and number of complications predicted 63% of the variance of the total FIM score (F6,88 = 24.64; P < .0001). Total FIM, depression, and Stroke Impact Scale Emotion subscale predicted 45% of the Perceived Stress Scale score (F6,88 = 12.04; P < .0001).

Conclusions: Variables that predict the stroke survivors' recovery are complex as the severity of the stroke combines with demographic and economic variables and depression to predict functional independence and perceived stress. These factors need to be considered when preparing a discharge plan for stroke survivors who are discharged home from rehabilitation.

Sharon K. Ostwald, PhD, RN, FGSA Professor and Isla Carroll Turner Chair in Gerontological Nursing, Center on Aging, University of Texas School of Nursing, Houston.

Paul R. Swank, PhD Professor, University of Texas Medical School, Houston.

Myrna M. Khan, PhD Senior Methodologist, Baylor College of Medicine, Michael E. De Bakey VA Medical Center, Houston, Texas.

This work was supported by the National Institutes of Health, National Institute for Nursing Research, RO1 NR005316 (S. K. Ostwald), and the Isla Carroll Turner Friendship Trust.

Corresponding author Sharon K. Ostwald, PhD, RN, FGSA, University of Texas School of Nursing, SONSCC Room 644, 6901 Bertner St, Houston, TX 77030 (

© 2008 Lippincott Williams & Wilkins, Inc.