Interactive effect of cognitive function and intervention on the walking independence of stroke patients: A retrospective cohort study

Abstract

The purpose of this study was to investigate the interactive effect of cognitive function and intervention on walking independence of stroke patients. Stroke patients (n=405) who admitted to convalescent reha-bilitation ward, were classified as being walking independent or depen-dent. To examine the interaction between cognitive function and inter-vention, high cognitive function (functional independence measure score =20) and physical therapy and occupational therapy intervention delivered in 1 day (lasting >2 hr) were defined as cognition-intervention interaction and included as independent variables. The incidence of walking independence was calculated using Kaplan-Meier curves. In-tergroup differences were estimated using log-rank test. Cox propor-tional hazards analysis was used to extract the predictors of walking in-dependence. Survival analyses using Kaplan-Meier log-rank test showed that the probability of incidence of walking independence was significantly higher in the presence of a cognition-intervention interac-tion. The results of Cox proportional hazards analysis showed that age, left versus right cerebral damage, and cognition-intervention interac-tion significantly influenced walking independence at discharge from the hospital. The hazard ratios were 0.971 per year of age, 0.544 for left versus right cerebral damage, and 1.794 for cognition-intervention inter-action. Walking independence was more likely to be achieved by stroke patients with high cognitive function who received therapy. In other words, the conditions that increase the likelihood of an effect of therapy intervention on walking independence were identified in this study.