symptoms and independence in BADL and IADL
Sue-Min Lai, PhD, MS, MBA; Pamela W. Duncan, PhD, FAPTA; John Keighley, MS; Dallas Johnson, PhD
Department of Preventive Medicine and Center on Aging, University of Kansas Medical Center, Kansas City, KS; Brooks Center for Rehabilitation Studies, Department of Health Policy and Management, University of Florida, and Rehabilitation Outcomes Research Center, North Florida/South Georgia Department of Veterans Affairs, Gainesville, FL; Department of Statistics, Kansas State University, Manhattan, KS
Abstract — Purpose.
This study examined the relationship between depressive symptoms and time courses
in achieving independence in basic activities of daily living (BADL) and instrumental
activities of daily living (IADL). Methods.
At baseline, 1, 3, and 6 months after stroke, 459 stroke patients were prospectively
assessed. We used the Geriatric Depression Scale to determine depressive status.
Outcomes were times to achieve independence in BADL (Barthel >95)
and independ-ence in at least three IADL. We used the Kaplan-Meier method and
time-dependent Cox proportional hazards regression to examine the relationship
between depression and stroke recovery. Results.
Depressed patients were 0.3 times less likely than nondepressed patients to
achieve BADL of >95 and 0.4
times less likely to be independent in three or more IADL. The cumulative percentages
for the nondepressed patients to achieve a BADL of >95
at 1, 3, and 6 months after stroke were 47%, 63%, and 72%, and for the depressed
patients, they were 19%, 34%, and 52%, respectively. Similarly, the cumulative
percentages for nondepressed patients to achieve complete independence in three
or more IADL at 1, 3, and 6 months after stroke were 56%, 72%, and 85%, and
for the depressed patients, they were 32%, 47%, and 72%, respectively. Depressed
patients had poorer recovery patterns and took longer to achieve the outcomes.
Conclusion. Stroke patients with depressive
symptoms progressed slower in achieving independence of BADL and IADL compared
to patients without depressive symptoms.
Key words: ADL, BADL, basic and instrumental activities of daily living recovery, depressive symptoms, IADL, stroke.