Motivation in veterans with an acute/subacute ischemic stroke did not improve cognition and functional motor recovery but reduced deaths.

Abstract

Background: The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.

Aim: This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.

Design: Prospective, observational, single-center study.

Setting: Enrollment was undertaken in an inpatient neurorehabilitation facility.

Population: A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.

Methods: Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.

Results: The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).

Conclusions: A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.

Clinical rehabilitation impact: The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.