The Impact of Comorbidities on Functional Outcomes After Rehabilitation in Stroke Patients

Background: Comorbidities are common among stroke survivors and may substantially influence functional recovery during rehabilitation; therefore, in this study, we aimed to evaluate the impact of individual comorbidities on functional outcomes in stroke patients after inpatient rehabilitation. Methods: In this retrospective cohort study, we included 289 patients with first-ever ischemic or hemorrhagic stroke who had undergone inpatient rehabilitation and assessed functional outcomes using the Barthel Index (BI), gait speed, Berg Balance Scale (BBS), and Action Research Arm Test (ARAT) at admission, after three weeks, and at discharge. The impact of selected comorbidities, including hypertension, diabetes mellitus, depression, cardiomyopathy, peripheral arterial disease, hyperlipidemia, and atrial fibrillation, was analyzed using multivariable logistic regression. Results: Significant improvements were observed across all functional measures (p < 0.0001). Diabetes mellitus and depression were independently associated with poorer improvement in BI, while reduced improvement in gait speed was associated with higher National Institutes of Health Stroke Scale (NIHSS) score, older age, female sex, cardiomyopathy, atrial fibrillation, and depression. Cardiomyopathy was also associated with reduced balance improvement measured by BBS, while vascular comorbidities were linked to less favorable upper limb recovery. Conclusions: Inpatient rehabilitation leads to significant functional recovery after stroke; however, specific comorbidities adversely affect rehabilitation outcomes. Targeted assessment and management of metabolic, cardiovascular, and psychological comorbidities may enhance functional recovery in stroke patients.