Contextual and clinical factors as explainers of stroke severity, residual motor impairments, and functional independence during hospitalization

Abstract

Objective

To investigate if contextual and clinical factors would explain stroke severity, residual motor impairments, and functional independence in people with stroke during hospitalization.

Materials and methods

This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were contextual (sex, age, marital status, occupation, and local of residence) and clinical (stroke type, length of hospital stay, and cognitive function) factors. Stroke severity (National Institutes of Health Stroke Scale), residual motor impairments (Fugl-Meyer scale), and functional independence (Functional Independence Measure) were the dependent variables. Stepwise multiple linear regression analysis was used (α=5%).

Results

Data from 1.606 individuals (64±15 years old) were retrieved. Cognitive function was the strongest explainer of all models, as follows: severity (23%;p<0.001), residual motor impairment (16%;p<0.001), and functional independence (32%;p<0.001). Length of hospital stays was the second explainer, adding from 7% to 8% to the models, while stroke type was the third explainer, adding 1% to all models. Finally, age was the last explainer of the two models, adding 1% to the severity and functional independence model.

Conclusion

The clinical variables explained more the dependent variables (all three were included in the models), than contextual variables (only age was included). Lower cognitive function, a clinical variable that is quick and easy to evaluate, best explained worse severity, residual motor impairments, and functional independence in people with stroke during hospitalization. Although higher length of hospital stays, hemorrhagic stroke, and older age added little to the explained variance, they should not be underlooked.