Obesity and Depression Impact on Key Inpatient Rehabilitation Outcomes Among Patients with Stroke: A Single Institution Experience

Background and/or Objectives: To determine whether patients with obesity and depression comorbid diagnoses in patients with ischemic stroke demonstrate less favorable inpatient rehabilitation clinical outcomes than patients with obesity, depression or neither comorbidity.

Design: Cross-sectional analysis

Setting : Quaternary care inpatient rehabilitation facility (IRF).

Participants : Patients admitted with a primary diagnosis of cerebral infarction between October 2019 and November 2022. Five hundred ninety-nine patients were categorized by body mass index (BMI in kg/m²): < 25, 25-29.9, 30-35, ≥35, and presence of depression (ICD-10 code Z13.31).

Interventions: NA

Main Outcome Measures: Length of stay (LOS); therapy resource use (minutes); met GG functional goals by discharge; discharge destination. Univariate analyses of covariance and non-parametric statistics were applied.

Results: LOS was longest in patients with both BMI>35 and depression (23.8±10.8 days) versus other groups (range 15.9±6.5 to 18.8±9.1 days; p<.05). The proportion of patients who achieved GG functional goals for self-care activity, transfers, or ambulation tasks was not different among BMI bracket or by depression. Therapy participation did not differ by BMI or depression (physical therapy minutes ranged from 611-737, occupational therapy ranged 641-694 minutes, and speech-language therapy ranged 245-382 minutes). However, depression was independently associated with 25.3%-79.3% more group therapy time (p=0.029), more therapy interruptions (5.1% vs 1.2% of patients; p=0.021) and a greater number of medication classes per BMI bracket (p=0.001; primarily due to administration of ‘central nervous system agents’). The fewest patients with depression and BMI >35 went home/home health compared to other groups (58.3% home, vs 72.7%-78.6% of other groups).

Conclusions: While BMI or depression did not impede meeting functional goals, patients who have BMI>35 and comorbid depression require longer stays and are less likely to go home. Engaging in more group therapy and use of appropriate central nervous system agents in the IRF may facilitate meeting goals especially in patients with depression.