Patient and family member factors influencing outcomes of poststroke inpatient rehabilitation

Abstract

Objective To investigate how family members’ attitudes toward functional regain, and patients’ knowledge and intention of independence influence poststroke rehabilitation. Design Cross-sectional study. Setting Three rehabilitation inpatient settings. Participants Younger (n=79) and older (n=84) poststroke patients, along with their family members (spouses, n=104; children, n=59). Interventions Not applicable. Main Outcome Measures Custom-designed questionnaires were used to tap into the patients’ knowledge about rehabilitation (Patient's Rehabilitation Questionnaire–Knowledge About Rehabilitation) and intention of independence (Patient's Rehabilitation Questionnaire–Intention of Independence), and family members’ attitudes toward patients in performing basic activities of daily living (BADL) (Family Member Attitudes Questionnaire–BADL) and instrumental activities of daily living (Family Member Attitudes Questionnaire–instrumental activities of daily living). The rehabilitation outcomes included gains in motor, cognitive, and emotional functions, and self-care independence, measured with common clinical instruments. Results The Family Member Attitudes Questionnaire–BADL predicted cognitive outcome and the Patient's Rehabilitation Questionnaire–Intention of Independence predicted motor outcome for both groups. Differential age-related effects were revealed for the Patient's Rehabilitation Questionnaire–Intention of Independence in predicting emotional outcome only for the younger group, and self-care independence only for the older group. Conclusions Patients’ intention of independence positively affected motor recovery, while family members’ positive attitudes promoted cognitive regain. The findings suggested plausible age-related differences in how patients’ intentions affect emotion versus self-care independence outcomes. Future studies should explore strategies for promoting positive attitudes toward independence among patients and family members during poststroke rehabilitation.