Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis

Objective To examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people poststroke during the time they received outpatient therapies. Design Retrospective analyses of an observational cohort using hierarchical linear modeling. Setting Outpatient rehabilitation. Participants Persons poststroke (N=366). Interventions Usual outpatient physical and occupational therapy. Main Outcomes Measures Berg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and covariance between slopes and intercepts were modeled as random effects. Additional variables modeled as fixed effects were duration (months of outpatient therapy), time (days poststroke), age (y), and inpatient status (if the patient went to an inpatient rehabilitation facility [IRF]). Results A patient with average age and time started at 37 points on the BBS with a change of 1.8 points per month, at 35 points on the ARAT with a change of 2 points per month, and with a walking speed of .59m/s with a change of .09m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF. Conclusions Patients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all 3 domains were small.