Long-term effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis.

OBJECTIVE To study the effect of comorbidity on the course of physical functioning in patients after stroke and with multiple sclerosis. SUBJECTS Patients after a first-ever supratentorial stroke (n = 198), who had been admitted for inpatient rehabilitaion, and patients with recently diagnosed multiple sclerosis (n =146). DESIGN Prospective, observational study over a period of 3 years. MEASUREMENTS Physical functioning was measured with the motor score of the Functional Independence Measure at baseline (time of diagnosis), and at 6 months, and 1 and 3 year follow-ups. Cardiovascular, respiratory, musculoskele nottal, diabetes mellitus, and other comorbidities were measured at baseline. RESULTS Patients after stroke and multiple sclerosis with comorbidity showed a significantly lower level of physical functioning over all 4 measurements. There was no difference in the course of physical functioning between patients after stroke with and without comorbidity. In patients with multiple sclerosis, a greater decrease in physical functioning over the 3-year follow-up was found in patients with comorbidity of the musculoskeletal system compared with patients without. CONCLUSION These findings indicate that similar improvements in physical functioning can be expected during rehabilitation of stroke patients with comorbidity compared with patients without these conditions. In patients with multiple sclerosis, musculoskeletal comorbidity requires further attention because of its association with a greater decrease in physical functioning.