A systematic review of stroke, delirium and allied health interventions; an exercise in futility.

Abstract

Background and Aims: Delirium is a neglected complication of stroke and characterised by fluctuating disturbance of consciousness, inattention and deficits in cognition. It is generally associated with poor functional outcome, increased morbidity and mortality, and greater incidence of institutionalisation.

Method: We planned a systematic review to study the impact of delirium on post- stroke rehabilitation. However, there is a surprising lack of published research. We then expanded our search to include all acute medical and surgical admissions.

Results: A number of studies were identified that showed correlation between delirium and poor functional outcome, and greater rates of institutionalisation and mortality. This impact was greater in patients with significant pre-existing co-morbidity and poorer functional status prior to admission. We found a single case study that attempted to address the issue of the negative impact of delirium on participation in rehabilitation. No research specifically addresses the impact of delirium on post-stroke rehabilitation, or factors that might influence short-term outcomes in these patients.

Conclusion: This literature search has identified an important gap in current research. We need to understand the impact of delirium on participation in post-stroke rehabilitation and outcome. If a discrepancy in participation is identified, it will allow for improvements in directed interventions in those at risk, including the use of non-pharmacological and pharmacological therapy. This will ultimately result in reduced burden of disease for patients, carers and the healthcare system. The promise of ever-improving acute stroke care will come to naught, if patients are unable to benefit from unhindered participation in rehabilitation.