Multimorbidity and functional motor and balance outcomes post-stroke: A retrospective analysis across all age groups

Abstract

Background & Objective: Multimorbidity is defined as the co-existence of two or more chronic conditions, which is common in stroke survivors and may influence their functional recovery. However, its impact on post-stroke outcomes remains poorly understood especially in a lower-to-middle income country. This study aimed to describe the distribution and severity of multimorbidity among post-stroke patients and examine its association with sociodemographic and clinical factors and its correlation with motor and balance outcomes; and to examine predictors of functional these outcomes.

Methods: This is a retrospective cross-sectional study on medical records of patients with first-time ischemic or hemorrhagic stroke referred to the physiotherapy division, in Universiti Malaya Medical Centre between January 2022 and December 2023. Inclusion criteria included age ≥18, at least two chronic conditions, and availability of Motor Assessment Scale (MAS) and/or Berg Balance Scale (BBS) scores. Multimorbidity was measured using the Charlson Comorbidity Index (CCI). Functional motor performance and balance were assessed using the Motor Assessment Scale (MAS) and Berg Balance Scale (BBS), respectively at an average of 6.5 months post-stroke (SD = 2.61). Statistical methods included Chi-square test, Spearman’s correlation, and multiple linear regression.

Results: A total of 384 patients were included in the analysis. Most patients (83.3%) had severe multimorbidity (CCI ≥5). The most common comorbidity was diabetes (48.9%) followed by dementia (17.2%). CCI severity was significantly associated with age group (p<0.0001) and ethnicity (p=0.010). No significant correlation was found between CCI and MAS (ρ = –0.014, p=0.870) or BBS (ρ = 0.073, p=0.258). Age was the only significant predictor of MAS (B = –0.322, p=0.016). CCI did not predict MAS or BBS outcomes.

Conclusions: Although multimorbidity is highly prevalent in post-stroke patients and associated with demographic factors, it was not significantly related to functional motor and balance performance. Age remains a key factor influencing functional motor performance. These findings emphasize the need for individualized rehabilitation strategies especially in the older stroke survivors.