An exploration of central nervous system medication use and outcomes in stroke rehabilitation.

Conroy B, Zorowitz R, Horn SD, Ryser DK, Teraoka J, Smout RJ. An exploration of central nervous system medication use and outcomes in stroke rehabilitation.

OBJECTIVE

To study associations between neurobehavioral impairments, use of neurotropic medications, and outcomes for inpatient stroke rehabilitation, controlling for a variety of confounding variables.

METHODS

Observational cohort study of post-stroke rehabilitation.

METHODS

Six inpatient rehabilitation hospitals in the United States.

METHODS

Patients with moderate or severe strokes (N=919).

METHODS

Not applicable.

METHODS

Discharge disposition, FIM score change, and rehabilitation length of stay (LOS).

RESULTS

Neurobehavioral impairments and use of many medications, including first-generation selective serotonin reuptake inhibitors, older traditional antipsychotic medications, and anti-Parkinsonian neuro-stimulants, have a statistical association with poorer outcomes, whereas use of the atypical antipsychotic medications has a positive association with improvement in motor FIM scores. Counter-intuitively, use of opioid analgesics is associated with a larger motor FIM score change but not an increase in LOS or reduced percentage of discharge to community. There was significant variation in use of neurotropic medications among the 6 study sites during inpatient stroke rehabilitation.

CONCLUSIONS

There are many opportunities to enhance a stroke survivor's ability to benefit from acute inpatient stroke rehabilitation through improved understanding of associations of neurotropic medications with outcomes for different patient groups.