# TIME COURSE FOR ACQUIRING TOILETING INDEPENDENCE IN PATIENTS WITH SUBACUTE STROKE: A PROSPECTIVE COHORT STUDY

## TL;DR

This study identifies three distinct time courses for stroke patients gaining independence in toileting tasks during rehabilitation, which can help therapists tailor interventions.

## Contribution

The study introduces a classification of three time courses for toileting independence in subacute stroke patients.

## Key findings

- Patients were grouped into three clusters based on their toileting independence progression.
- Cluster 2 patients showed significant improvement in independence during hospitalization.
- Cluster 3 patients remained dependent on toileting tasks until discharge.

## Abstract

To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients.

Single-institution, prospective cohort study.

A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission.

Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2–4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis.

Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7–100% of patients performed each subtask independently] to the endpoint [73.3–100%]), Cluster 2 (41 patients who showed less independence upon admission [0–26.8%] but gained greater independence at the endpoint [34.1–73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0–26.7%] to the endpoint [3.3–26.7%]).

Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.

For patients after a stroke, acquiring toileting independence is critical in rebuilding their lives. Toileting consists of multiple subtasks, including entering and exiting bathrooms, transferring from the wheelchair to the toilet seat, and manipulating lower garments. Understanding the potential processes towards independence in toileting subtasks helps therapists prioritize subtasks for patients to practise and develop effective strategies to promote independence. We examined the changes in the independence level of toileting-related subtasks in 101 stroke patients and found that the process can be classified into 3 time courses as follows: patients who were nearly independent in many subtasks upon admission and became independent early during hospitalization; patients who required assistance with many subtasks upon admission but could perform many subtasks independently during their hospitalization; and patients who required assistance upon admission and remained dependent on discharge. Different intervention strategies are required for each group to facilitate the acquisition of toilet-related tasks.