Abnormal illness behaviour in rehabilitation from stroke

Objective: To examine the effect of abnormal illness behaviour (AIB) on rehabilitation outcome following stroke.

Design: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and 12 months after discharge.

Setting: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia.

Subjects: Ninety-four 12-month stroke survivors who had undergone an inpatient rehabilitation programme.

Main outcome measures: AIB was assessed using the Illness Behaviour Questionnaire. Additional psychological measurements comprised the Zung Self-Rating Depression Scale, General Health Questionnaire, and a visual analogue mood scale. Functional ability was assessed with the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index.

Results: Cluster analysis of discharge data was used to define a rule for identifying patients with AIB. AIB was apparent in nearly 30% of patients at discharge, and persisted for 12 months. Patients with AIB scored more poorly than non-AIB patients on functional, social and psychological indicators.

Conclusions: AIB emerged as a key determinant of long-term disability. It is important to consider why AIB develops during rehabilitation, and how to identify patients at risk.