Change in mobility activity in the second year after stroke in a rehabilitation population: Who is at risk for decline?

Objectives: To investigate the development of mobility status during the second year after stroke in patients who had had inpatient rehabilitation, and to evaluate risk factors for mobility decline. Design: Evaluation of change in Rivermead Mobility Index (RMI) score over the second year after stroke in an inception cohort of first-ever stroke patients eligible for inpatient rehabilitation. Logistic regression techniques were used to predict decline. Independent variables were measured with standardized instruments 1 year after stroke. Setting: Home or institution, after discharge from rehabilitation center. Participants: Patients (N = 148) with single first-ever stroke (supratentorial), age more than 18 years. Interventions: Not applicable. Main Outcome Measures: Decline of 2 or more points on the RMI and the percentages and odds ratios (ORs) for decline. Results: The mean RMI score did not significantly change over time. Mobility declined in 12% of the patients. Mobility decline was found more often in patients with depression (25%) than without (7%), with right-sided weakness (17% vs 8%), with ischemic stroke (13% vs 8%), with aphasia (22% vs 11%), with cognitive dysfunction (17% vs 11%), with comorbidity interfering with locomotion (25% vs 12%), with poor social functioning (15% vs 10%), and with mobility disability (16% vs 8%). Statistical significance was found only for depression (OR=4.2; 95% confidence interval, 1.3-13.2). Conclusions: Most patients maintained the level of mobility they achieved during inpatient rehabilitation over the second year after stroke. Only 12% had a decline in mobility, and depression was the only statistically significant predictor for decline.