Prediction of everyday verbal communicative ability of aphasic stroke patients after inpatient rehabilitation

Abstract

Background: Early accurate prediction of verbal communicative ability at discharge from inpatient rehabilitation is essential for rehabilitation professionals to provide reliable prognostic information to the aphasic patient and family, and to make appropriate treatment decisions. Aims: To develop a prediction model for verbal communicative ability at discharge from inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at rehabilitation admission. Methods & Procedures: Eighty-four stroke patients with moderate-to-severe aphasia were selected from a cohort of aphasic patients who enrolled in an inpatient rehabilitation programme from September 2010 to September 2013. From a group of eight candidate prognostic factors (demographic, neurological, and language variables, and the ictus-to-admission interval), those significantly associated with verbal communication (Amsterdam–Nijmegen Everyday Language Test scale A) at discharge were selected by means of multiple linear regression analyses. Outcomes & Results: A prognostic model of verbal communication was constructed, including verbal communicative ability and the phonology score at admission as independent predictors, which explained 64% of the adjusted variance. The ictus-to-admission interval was a marginally significant predictor. Age, sex, stroke type, activities of daily living dependency, and semantics did not make significant contributions to the prediction model. Conclusions: The results of this study represent a first step in the development of a prediction model for verbal communication outcome after inpatient rehabilitation in stroke patients with moderate-to-severe aphasia at admission. After the performance of the prognostic model has been externally validated, it can be used to inform patients with moderate-to-severe aphasia and their families about the expected recovery of verbal communicative ability after inpatient rehabilitation, and it may guide clinicians, patients, and their relatives in shared decisions on the most appropriate treatment approach to improve functional communication.