An exploration of central nervous system medication use and outcomes in stroke rehabilitation

Objective: To study associations between neurobehavioral impairments, use of neurotropic medications, and outcomes for inpatient stroke rehabilitation, controlling for a variety of confounding variables. Design: Observational cohort study of poststroke rehabilitation. Setting: Six inpatient rehabilitation hospitals in the United States. Participants: Patients with moderate or severe strokes (N=919). Interventions: Not applicable. Main Outcome Measures: Discharge disposition, FIM score change, and rehabilitation length of stay (LOS). Results: Neurobehavioral impairments and use of many medications, including first-generation selective serotonin re-uptake inhibitors, older traditional antipsychotic medications, and anti-Parkinsonian neurostimulants, have a statistical association with poorer outcomes, whereas use of the atypical antipsychotic medications has a positive association with improvement in motor FIM scores. Counterintuitively, use of opioid analgesics is associated with a larger motor FIM score change but not an increase in LOS or reduced percentage of discharge to community. There was significant variation in use of neurotropic medications among the 6 study sites during inpatient stroke rehabilitation. Conclusions: There are many opportunities to enhance a stroke survivor's ability to benefit from acute inpatient stroke rehabilitation through improved understanding of associations of neurotropic medications with outcomes for different patient groups.