Continence Status at Rehabilitation Admission Poststroke Does Not Predict 3- to 4-Year Institutionalization

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Abstract
Poststroke urinary incontinence has been associated with death, poor functional outcome, and institutionalization. No studies have evaluated the impact of urinary incontinence on the placement of stroke survivors 3 to 4 years poststroke. Two hundred thirty first-time stroke survivors admitted consecutively to a stroke rehabilitation unit between August 1991 and August 1992 were screened for signs and symptoms of voiding dysfunction. Of these, 172 (74.7%) subjects were contacted and interviewed an average of 3.5 years poststroke. Of these, 10 (5.8%) subjects were institutionalized. Institutionalization at follow-up was not correlated with urinary incontinence at rehabilitation admission (χ2 = 3.52, p = 0.08) but was correlated with urinary incontinence at follow-up (χ2 = 6.77, p = 0.02, relative risk 5.75 [95% CI 1.26, 26.1]). Death of incontinent stroke survivors prior to follow-up may have weakened the correlation between urinary incontinence and institutionalization. However, incontinence was a major factor in the institutionalization decision in 6 of 6 (100%) subjects who were incontinent and remained so after stroke onset.