First aggression as a planning signal in post-acute stroke rehabilitation: Service benchmarks, goal setting, and a 60-day precaution window from a comprehensive observational cohort
In brief
Post-stroke rehab aggression risk reached 16% over 60 days
In a single-center cohort of 1,683 adults in post-acute stroke rehabilitation, the estimated risk of first documented aggression was 8% at 30 days and 16% at 60 days. Patients with aggression also had longer stays and more urinary tract infections and falls, but these observational benchmarks need multicenter validation before guiding care broadly.
- Journal
- PM & R : the journal of injury, function, and rehabilitation (Q1)
- Published
- 9 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Alejandro García-Rudolph, Elena Hernandez-Pena, Alicia Romero, Mark Andrew Wright, Joan Saurí, Claudia Teixido-Font, et al.
- PMID
- 42855834
- DOI
- 10.1002/pmrj.70225
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 11 October 2026): Aggression impacts LOS, functional gains in stroke rehab
Abstract
BACKGROUND: Aggressive behavior after stroke is common and linked to poorer outcomes, yet prior studies have not translated this knowledge into operational benchmarks that guide planning (time-limited risk windows, realistic goals, discharge timelines) during postacute rehabilitation. OBJECTIVE: To quantify service benchmarks after the first electronic health record (EHR)-documented aggression and map them to a standardized, time-boxed response: event rates and short-horizon risks (30/60 days), functional/length-of-stay (LOS) gaps in clinical units, and practical targets for planning. DESIGN: Retrospective observational cohort with prespecified 1:1 propensity-matched sensitivity analysis. SETTING: Single tertiary neurorehabilitation hospital (postacute, inpatient). PATIENTS: Adults with first-ever ischemic or hemorrhagic stroke admitted ≤3 months post stroke between 2005 and 2023 (N = 1683). Aggression was flagged at the first qualifying EHR annotation; 317 (18.8%) had more than one episode. OUTCOME MEASURE(S): Incidence densities (per 1000 patient-days) and derived 30-/60-day risks for first aggression, urinary tract infection, and falls; between-group differences in LOS and motor Functional Independence Measure (mFIM) outcomes (gain, efficiency, effectiveness) summarized as median differences (Hodges-Lehmann). RESULTS: Across 111,945 patient-days, first-aggression incidence was 2.83/1000 (95% CI: 2.53-3.16), implying 8.1% 30-day and 15.6% 60-day risks. Compared with nonaggressive patients, the aggressive group had higher urinary tract infection rates (rate ratio 1.92, 95% confidence interval [CI]: 1.43-2.57) and falls (rate ratio 1.28, 95% CI: 1.00-1.63). Functional gaps (median differences, Hodges-Lehmann) favored the nonaggressive group: LOS was longer (+17.9 days, 95% CI +13.8 to +22.0), mFIM efficiency and effectiveness were lower in the full cohort; in the matched subset (317 vs. 317), Hodges-Lehmann differences persisted (eg, LOS +9.8 days, 95% CI +4.1 to +15.2). CONCLUSIONS: A single EHR-documented aggression provides a planning signal: event rates and 30-/60-day risks justify a 60-day precaution window, and scaled gaps support realistic goal setting (mFIM) and discharge date updates. These benchmarks offer a framework for bedside counseling, service targets, and audit; multicenter validation is warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.