Is communication key in stroke rehabilitation and recovery? National linked stroke data study

ABSTRACT

Background

Information on the characteristics or long-term outcomes of people with communication support needs post-stroke is limited. We investigated associations between communication gains in rehabilitation and long-term outcomes (quality-of-life [EuroQOL-ED-3 L], mortality) by post-stroke communication support need status.

Methods

Retrospective cohort study using person-level linked data from the Australian Stroke Clinical Registry and the Australasian Rehabilitation Outcomes Centre (2014–2017). Communication support needs were assessed using the Functional Independence Measure™ comprehension and expression items recorded on admission indicated by scores one (total assistance) to five (standby prompting). Multivariable multilevel and Cox regression models were used to determine associations with long-term outcomes.

Results

Of 8,394 patients who received in-patient rehabilitation after stroke (42% female, median age 75.6 years), two-thirds had post-stroke communication support needs. Having aphasia (odds ratio [OR] 4.34, 95% CI 3.67–5.14), being aged ≥65 years (OR 1.21, 95% CI 1.08–1.36), greater stroke severity (unable to walk on admission; OR 1.48, 95% CI 1.32–1.68) and previous stroke (OR 1.25, 95% CI 1.11–1.41) were associated with increased likelihoods of having communication support needs. One-point improvement in FIM™ expression was associated with reduced likelihood of self-reporting problems related to mobility (OR 0.85, 95% CI: 0.80–0.90), self-care (OR 0.79, 95% CI: 0.74–0.86) or usual activities (OR 0.84, 95% CI: 0.75–0.94) at 90–180 days. Patients with communication support needs had greater mortality rates within one-year post-stroke (adjusted hazard ratio 1.99, 95% CI: 1.65–2.39).

Conclusions

Two-thirds of patients with stroke require communication support to participate in healthcare activities. Establishing communication-accessible stroke care environments is a priority.

KEYWORDS:

• Rehabilitation
• stroke
• registry
• data linkage
• communication disorders
• quality of life
• mortality

Acknowledgments

The authors of this study thank members of the Australian Stroke Clinical Registry (AuSCR) Steering and Management Committee and the Australasian Rehabilitation Outcomes Centre (AROC) Management Advisory Group. We would also like to acknowledge site investigators, clinicians and patients who contributed data to the AuSCR and the AROC.

Disclosure statement

Prof Cadilhac is the current Data Custodian for the AuSCR. Professors Cadilhac, Faux and A/Prof Kilkenny are members of the AuSCR Steering or Management Committees. Dr Ross Clifton is the Director of the Australasian Rehabilitation Outcomes Centre (AROC), and Ms Alexander is the AROC Database Manager and Statistician.

Additional information

Funding

This work was supported by the Australian Government under a Research Training Program (RTP) scholarship awarded to Sally Zingelman. The following authors received research fellowship support from the National Health and Medical Research Council: Professor Cadilhac (1154273), Dr Wallace (1175821), A/Prof Kilkenny (1109426). A/Prof Kilkenny reports receiving research fellowship support from the National Heart Foundation of Australia (105737) and Professor Natasha Lannin holds a Heart Foundation Future Leader Fellowship (106762).