African Americans and Women Have Lower Functional Gains During Acute Inpatient Rehabilitation After Hemorrhagic Stroke

Abstract

Objective: Intracerebral hemorrhage can lead to significant long-term disability. While research in stroke rehabilitation has focused primarily on ischemic strokes, identifying factors that impact recovery in patients with intracerebral hemorrhage is necessary. Our purpose is to identify factors, including racial and sex disparities, associated with functional outcomes in intracerebral hemorrhage patients after inpatient rehabilitation. Design: This was a retrospective analysis of consecutive patients with intracerebral hemorrhage admitted to an inpatient rehabilitation facility at an academic tertiary facility in the Southeastern United States from 2016 to 2019. Clinical characteristics, demographics, admission, and discharge Functional Independence Measure scores were collected. Results: We evaluated 59 patients (54.4 ± 14.1 yrs, 39% females, 48.2% African American) with a median intracerebral hemorrhage volume of 13.4 (4.2-33.0) and a mean (SD) Functional Independence Measure efficiency of 1.8 ± 1.3. In multiple regression, being female was negatively associated with Functional Independence Measure efficiency (β = −1.13, P = 0.0037) when adjusting for race and intracerebral hemorrhage score. The Functional Independence Measure efficiency was lower in African Americans (β = −0.97, P = 0.0119) when adjusting for sex and intracerebral hemorrhage volume. Conclusions:The results of our study indicate that Functional Independence Measure efficiency was worse for African Americans and female patients with intracerebral hemorrhage. Future research should consider these racial and sex disparities and focus on providing targeted rehabilitation therapy.

Authors’ Reply

“…We agree that early functional status is helpful in determining prognosis after stroke 1 . The admission and discharge FIM scores reported were obtained at inpatient rehabilitation and were not obtained during the acute hospitalization, as mentioned in the first line of “Outcome measures” in the Methods section of the article 2 . The primary focus of our manuscript was FIM efficiency.…”

Letter to the Editor on “African Americans and Women Have Lower Functional Gains During Acute Inpatient Rehabilitation After Hemorrhagic Stroke”

“…We agree that early functional status is helpful in determining prognosis after stroke. 1 The admission and discharge FIM scores reported were obtained at inpatient rehabilitation and were not obtained during the acute hospitalization, as mentioned in the first line of "Outcome measures" in the Methods section of the article. 2 The primary focus of our manuscript was FIM efficiency.…”

“…W e have read with great interest the article entitled "African Americans and women have lower functional gains during acute inpatient rehabilitation after hemorrhagic stroke" by Somani et al 1 The authors retrospectively analyzed data from 59 patients with intracerebral hemorrhage (ICH) who underwent rehabilitation therapy in an inpatient rehabilitation facility using multiple linear regression model. They concluded that African Americans and female ICH patients presented significantly poorer functional improvement after acute inpatient rehabilitation.…”

“…3 After 6 mos, the recovery nearly stalls. 3 Somani et al 1 have described that the patients underwent acute inpatient re-habilitation; hence, the enrolled patients had likely begun rehabilitation therapy within 1 mo after the ICH onset. Because the most dramatic functional recovery is observed over a period of 1 mo after the ICH onset, the authors should have investigated the days from the ICH onset and adjusted for it in the analysis.…”

“…Functional status at the early stage after stroke is widely known as one of the most critical factors affecting the functional prognosis 2 . If the admission FIM described by Somani et al 1 refers to the FIM measured at an early stage, it should have been adjusted when analyzing functional outcomes.…”