Effect of comorbidity on functional recovery in stroke patients

Introduction/Background The impact of comorbidities on stroke functional recovery has yet to be studied in Taiwan. This study evaluated the comorbidities and their impact on functional recovery in stroke patients. Material and method The participants were 105 acute stroke patients with moderate to severe functional disability who were admitted for comprehensive rehabilitation. Participants were 76 people who underwent Post-acute Care program and other 29 participants accepted a regular rehabilitation program within six months after stroke. The effect of each comorbidity on the patients’ post-hospitalization daily living activities was analyzed based on the Charlson Comorbidity Index (CCI). Results The average Barthel Index (BI) scores increased from 41.8 at admission to 75.5 at discharge; the average progress was 33.7 points. The stroke patients in control group had an average BI score of 37.2 at admission and 47.2 at discharge; the average progress was only 10 points. The functional recovery rate of daily living activities in the post-acute care group was equal to [(BI scoring improvement/BI at admission) × 100%] and was significantly higher than that of the control group (post-acute care: control = 1.4 ± 1.7/0.4 ± 0.6; P  = 0.015). For each 1 point increase to a patient's CCI score, there was a 0.97 point decrease to the patient's score on the BI after discharge from the hospital ( P  = 0.013). An analysis of 19 comorbidities showed that the order of highest prevalence was diabetes (21%), prior cerebrovascular accident with mild or no residual or transient ischemic attack (17.1%), and diabetes with end-organ damage (14.3%). Analysis of the impact of the various comorbidities on stroke patients’ daily living activities indicated that the most harmful disease was chronic pulmonary disease, followed by prior history of hemiplegia. Conclusion Comorbidities, especially chronic pulmonary disease and hemiplegia, can affect the functional recovery and daily living activities of stroke patients.