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Am J Phys Med Rehabil. 2003 Mar;82(3):175-81.

Influence of poststroke urinary incontinence on disability: the nursing home setting.

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Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.



To characterize the association of poststroke urinary incontinence with disability progression in nursing home residents.


In this prospective cohort study, the Minimum Data Set from the State of New York between 1994 and 1997 was utilized. From a pool of over 240,000 potential subjects, 500 met inclusion/exclusion criteria. Previously continent, first-time stroke survivors were classified as being continent or incontinent immediately after their stroke and were followed for changes in activities of daily living status (disability) at quarterly intervals for a 1 yr. In addition, a post hoc analysis was performed examining changes in activities of daily living status from the prestroke condition and exploring the relationship between poststroke impairments in continence and limitations in mobility.


An almost 2-fold difference in level of disability was noted poststroke among those who were incontinent those who were continent (P < 0.001). This difference in disability level remained unchanged for 1 yr. Through the post hoc analysis, it was determined that, although the onset of stroke produced significant elevations in disability for both continent and incontinent stroke survivors (P < 0.001), the presence of an impairment in urinary continence was associated with a significantly greater increase (94% 13%) in disability (P < 0.001). In addition, incontinence occurred more frequently among those who had a loss in mobility function.


Incontinence is a clinical factor after stroke that is associated with greater disability among nursing home residents. These findings have clinical implications for physiatrists and nursing home clinicians and provide a context in which future disability research can be conducted.

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