Orientation in the acute and chronic stroke patient: Impact on ADL and social activities. The Copenhagen Stroke Study

Objectives: To determine the influence of initially lowered orientation on rehabilitation outcome in stroke patients, and how decreased orientation 6 months after stroke influences ADL and social activities. Design: Prospective, consecutive, and community based. Setting: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were completed within the unit. Patients: 524 patients with acute stroke. Main Outcome Measures: Basic ADL assessed by the Barthel Index (BI) at discharge; discharge placement; higher level ADL and social functions assessed by the Frenchay Activity Index (FAI) at a B-month follow-up. Results: The independent influence of orientation in acute stroke on rehabilitation outcome was analyzed with multiple linear and logistic regression models, using initial stroke severity (Scandinavian Neurologic Stroke Scale), initial BI, age, sex, comorbidity, prior stroke, and marital status as covariates. A one-point decrease in orientation decreased BI with 9 points (coefficient b = 8.66, SE(b) = 1.02, p < .0001) and reduced the likelihood (1.49, 95% CI: 1.05 to 2.11) of discharge to independent living (b = .40, SE(b)= .18, p = .026). Followup examinations 6 month poststroke showed that decreased orientation at this point still exerted a marked, negative influence on ADL and social functions (BI: coefficient b = 12.06, SE(b) = 1.95, p < .0001; FAI: coefficient b = 6.28, SE(b) = 1.42, p < .0001). Conclusion: The level of orientation influences basic ADL and higher level ADL and social activities in acute as well as chronic stroke. This finding suggests that rehabilitation of memory and attention might be relevant in stroke patients with impaired orientation. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation