Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 1. Analysis of 248 unscreened patients--medical and functional prognostic indicators.

258

119

I used leg and arm paresis to predict outcome measured as extremity function in a prospective study of 75 consecutive hemiplegic patients admitted to an inpatient stroke rehabilitation unit. In each patient, extremity paresis was quantified according to the five-point scoring system advised by the Medical Research Council, upper extremity function was quantified using the Barthel Index subscore for feeding and dressing the upper body, and lower extremity function was quantified according to a five-point scoring of the ability to walk. Improvement was recorded for upper extremity function in 52% of the patients and for lower extremity function in 89%. Best extremity function was reached a mean±SEM of 9±3 and 10±4 weeks after stroke for the upper and lower extremities, respectively. In patients experiencing complete recovery, this occurred a mean±SEM of 7±2 weeks (for both upper and lower extremities) after the stroke. Only 8-11% of the patients with paresis scores of ^2 regained independent extremity function after rehabilitation. Half of the patients with paresis scores of ^3 regained independent extremity function after rehabilitation, while the other half were able to perform extremity function with only minimal assistance. As predictors of extremity function, the Barthel Index subscore was slightly better (r=0.64) than paresis score (r=0.58). However, because evaluation of extremity paresis is easy, it appears to be useful as a preliminary predictor of outcome following stroke. (Stroke 1990;21:247-251)

Section: Discussionmentioning

confidence: 99%

Arm and leg paresis as outcome predictors in stroke rehabilitation.

Olsen

1990

258

119

“…This finding contrasts with research showing that patients with more severe initial injury recover more slowly and to a lesser extent. 38 The failure to take social support into account may lead to an overly negative prognosis in patients with moderate to severe stroke.…”

Section: Support Timing: Graphic Analysismentioning

confidence: 99%

Impact of social support on outcome in first stroke.

Glass

Matchar

Belyea

et al. 1993

307

205

Background and Purpose: The purpose of this study is to examine the impact of social support on outcome after first stroke in a prospective cohort study. Although modest evidence exists for the importance of several psychosocial factors, studies have failed to use widely recognized measures of outcome and social support, have failed to control for time since onset, and have not used longitudinal techniques.

“…This finding suggests that the severity of stroke in these two patient groups is not equivalent. Although difficult to interpret, two recent studies 39 ' 60 cast further doubt about the importance of early rehabilitation and support the conclusion that patients who begin rehabilitation early are likely to be in better health initially.…”

Section: Issues In Rehabilitation For Stroke General Principles and Pmentioning

confidence: 99%

Rehabilitation for stroke: a review.

Dombovy¹,

Sandok²,

Basford³

1986

225

SUMMARY Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden. Many investigators have attempted to assess the role of rehabilitation in reducing such disability. Few controlled studies provide accurate assessment and documentation of benefit. Because of the presence of multiple variables and inadequate measures of outcome, it is difficult to design studies evaluating the effectiveness of rehabilitation for stroke. It is unclear bow early rehabilitation should begin and what aspects of rehabilitation are important. Intensive rehabilitation is an expensive and limited resource; thus, the ability to identify the subgroup of patients with stroke who are likely to benefit is a critical issue. Although preliminary guidelines for the selection of patients who are appropriate for rehabilitation are given, no uniform criteria reliably differentiate patients who need rehabilitation from those who will recover spontaneously or do poorly. Controlled studies in the practice of rehabilitation for stroke will provide much useful information for patient management.