Abnormal illness behaviour in rehabilitation from stroke.

OBJECTIVE

To examine the effect of abnormal illness behaviour (AIB) on rehabilitation outcome following stroke.

DESIGN

A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and 12 months after discharge.

SETTING

The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia.

SUBJECTS: Ninety-four 12-month stroke survivors who had undergone an inpatient rehabilitation programme.

MAIN OUTCOME MEASURES: AIB was assessed using the Illness Behaviour Questionnaire. Additional psychological measurements comprised the Zung Self-Rating Depression Scale, General Health Questionnaire, and a visual analogue mood scale. Functional ability was assessed with the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index.

RESULTS

Cluster analysis of discharge data was used to define a rule for identifying patients with AIB. AIB was apparent in nearly 30% of patients at discharge, and persisted for 12 months. Patients with AIB scored more poorly than non-AIB patients on functional, social and psychological indicators.

CONCLUSIONS

AIB emerged as a key determinant of long-term disability. It is important to consider why AIB develops during rehabilitation, and how to identify patients at risk.