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.