Abstract TP157: Patient and Physical Therapy/Occupational Therapy Characteristics Associated With Functional Mobility Outcomes After Mechanical Thrombectomy


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Abstract

Background and Purpose: Mechanical thrombectomy is now a standard of care therapy for large vessel stroke; however, patients often demonstrate variable outcomes, and do not return to independent function. Physical Therapy (PT) and Occupational Therapy (OT) after thrombectomy may play a vital role in maximizing patient recovery. The goal of this study was to examine the relationships between PT/OT and patient characteristics on mobility outcome in patients who have undergone thrombectomy after a stroke. The primary hypothesis was that earlier PT/OT evaluation would be associated with higher scores on the Kansas University Hospital Physical Therapy Acute Care Functional Outcomes Tool.Methods: A retrospective review was performed of 127 patients diagnosed with stroke who underwent mechanical thrombectomy at a Comprehensive Stroke Center 07/2011-02/2017. Collected data included demographics, National Institute of Health Stroke Scale (NIHSS), ICU/hospital length of stay, functional status (Kansas score), timing of PT/OT evaluation, and number of PT/OT sessions. To account for the collinearity of the covariates, the least absolute shrinkage and selection operator (LASSO) method was used to identify the best subset of predictors of change in Kansas score.Results: Median length of stay was four days in the ICU and eight days overall. Mean NIHSS at discharge was higher among those not receiving a PT/OT evaluation than among those who did (22.1 vs 8.8, respective, p<0.0001). This was likely explained by the fact that 97% of those who did not receive PT/OT were discharged to hospice or died during hospitalization. Despite this limitation, higher Kansas scores were significantly associated with shorter time to recanalization (β=-0.16 [0.07], p=0.03), earlier initial PT/OT evaluation (β=-0.45 [0.17], p=0.01), and lower Kansas score at initial evaluation (β=-0.19 [0.05], p<0.001).Conclusion: The data demonstrated that early recanalization time correlated to improved Kansas score. However, this study also demonstrated a significant relationship between earlier PT/OT evaluations and higher Kansas scores. Therefore, for patients who have undergone thrombectomy, earlier PT/OT evaluations could have significant impact on clinical outcomes.

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