Does pre-existing cognitive impairment impact on amount of stroke rehabilitation received?: an observational cohort study

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without.
Design: Prospective observational cohort.
Setting: Four UK inpatient stroke rehabilitation units.
Participants: 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. 33 participants were categorised with pre-existing cognitive impairment based on routine documentation by clinicians, 106 without.
Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to Early Supported Discharge and length of stay.
Results: On average participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference 16.0, 95% CI 2.9 to 29.2), which was not fully explained by adjusting for potential confounders (age, sex, NIHSS, pre-stroke mRS). Whilst those with pre-existing cognitive impairment received nine fewer single discipline physiotherapy sessions (95% CI 3.7 to 14.8), they received similar amounts of single discipline occupational therapy, psychology and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI -4.3 to -0.6) and nine fewer patient-facing occupational therapy sessions (95% CI 3.5 to 14.9). There was no evidence to suggest they were discharged earlier but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to Early Supported Discharge compared to 47 (75%) without.
Conclusions: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.