Urinary incontinence and stroke outcomes

To examine the relation of urinary incontinence to functional status and discharge destination in stroke rehabilitation patients.

Historical cohort.

Freestanding, not-for-profit rehabilitation hospital.

Nonrandom sampling. The charts of all admissions to the stroke rehabilitation unit were screened to identify patients with a medical diagnosis of completed stroke occurring 2 to 4 weeks before admission to rehabilitation, documented evidence of urinary incontinence at least daily the first 2 days after admission, and Functional Independence Measure (FIM) bladder sphincter score of 5 or less. Ninety patients met the inclusion criteria.

FIM, change in FIM scores from admission to discharge, weekly FIM gains, and discharge destination.

Continence status at discharge was not associated with discharge destination, but did predict total FIM score at discharge and the change in FIM scores from admission to discharge. Subjects who regained continence had higher weekly FIM gains on all subscales except Communication. A critical area of difference between the groups was in Social Cognition scores. The time interval from stroke greatly influenced the findings; in patients evaluated 14 to 18 days after stroke differences between continent and incontinent subjects were found only in Social Cognition scores, whereas in patients evaluated 27 to 30 days after stroke differences were found in Self-Care and Sphincter Control scores.

Further investigation into cognitive characteristics should be undertaken with a more comprehensive tool appropriate for an impaired population.