Occurrence of Urinary Tract Infections and Physical Functioning in Patients After Stroke

Abstract

Introduction: The majority of brain strokes result in a reduction of physical functioning and remain a major cause of disability. Post-stroke rehabilitation aims to improve physical functioning of patients who have suffered from stroke. Infections, including those of the urinary tract (UTI), are complications of stroke that occur in patients who undergo physical therapy at stationary departments of neurological rehabilitation and may significantly influence its effectiveness. Study aim: The main objective of the study is to assess the relationship between the UTI and physical functioning in patients after stroke, and the relationship between prevalence of UTIs and the results of rehabilitation in post-stroke patients. Material and methods: An observational case-control study was conducted, with a natural selection into the study groups according to the prevalence of UTI. Data was collected from the medical records of all stroke patients rehabilitated at the inpatient Neurological Rehabilitation Department of ORNR “Krzeszowice” in Krzeszowice during the period from 01 Jan. 2012 to 31 Dec. 2014. The study included 400 patients. Physical functioning was assessed using the Barthel and Rankin scales. Results. UTI occurred in 37.5% of patients. In the univariate analysis, the occurrence of UTIs was associated with worse physical functioning at admission and discharge. After adjustment to the influence of gender, age, side and type of stroke, the time since discharge from the stroke unit, the presence of diabetes and use urinary catheter, better physical functioning at admission to the neurological rehabilitation unit was inversely related to the occurrence of UTI (according to the Barthel scale: OR = 0.89, 95% CI: 0.85-0.94); according to the Rankin scale: OR = 1.75; 95% CI: 1.33-2.32). At discharge, after adjustment for: influence of physical functioning at admission to the ward and other confounding factors, the occurrence of UTI was not significantly correlated with the physical functioning of patients. During hospitalisation, physical functioning improved in both groups, but among the group of patients with UTI, the dynamics of the change was significantly greater than in patients without UTI. Conclusions. In stroke patients referred to inpatient neurological rehabilitation, UTIs are a common complication. The occurrence of UTI was associated with decreased physical functioning at admission to the department, but in patients with UTI, more dynamic improvement in physical functioning was found during rehabilitation. The incidence of UTI was not related to physical functioning at discharge from the ward.