On the prognosis of outcome after stroke

Abstract

Objectives– The study was aimed at improving the accuracy of prognosis for recovery of function in patients suffering a first stroke. Materials and methods– Two‐hundred and forty‐eight patients were enrolled. The mean interval since the stroke was 23 days. Patients entered a rehabilitation program lasting 60 days. The predictive value of 12 factors were analysed, namely motor, cognitive and sphincter subitems of Functional Independence Measure at admission (FIM‐a), age, sex, education, body mass index (BMI), depression, neglect, aphasia, ideomotor and constructive apraxia. FIM score at discharge was the dependent variable. Results– A multiple regression revealed that only age, cognitive and sphincter subitems of FIM‐a, neglect and ideomotor apraxia were significantly associated with outcome. Moreover, these factors accounted for only 72% of the variance in outcome scores. A decision of unfavourable prognosis on the basis of a FIM‐a value lower than 40 was incorrect in 2.8% of the patients in this study and in 8.2% of those having a FIM score lower than 40. Conclusions– The use of statistical methods to examine the outcome after stroke is useful for expressing probability on a group basis but is unsuitable for determining the prognosis of individual patients. Such data should not be used for fiscal management. A significant minority of patients presenting with a FIM lower than 40 can regain a useful measure of independence. The errors in prognosis based upon available methods, although small, have unacceptable effects in human terms if they lead to the clinical decisions which deny patients rehabilitation. All of the patients should therefore be admitted for rehabilitation after their first stroke. Severe comorbidity requires special attention.

Evolution on Cognitive Rehabilitation after Stroke: from Traditional Techniques to Smart and Personalised ICT Home-based Systems

“…The Functional Independence Measure provides a rough evaluation of the performance of ADL at home or at hospitals and this score was used in order to establish a correlation between outcome and Apraxia [32]. A similar approach, the Physical Self-Maintenance Scale, is also used to measure the percentage of assistance by caregivers.…”

Factors influencing outcomes in patients with stroke

“…Daugelis autorių nurodo, kad pažeistos kūno pusės neigimas, pasireiškiantis insulto ūminės fazės metu, yra svarbus blogos ligos baigties prognozinis veiksnys (39)(40)(41).…”

“…S. Giaquinto ir kiti autoriai, analizavę pacientų, persirgusių insultu, funkcinės būklės atsigavimo prognozę, padarė išvadą, kad ideomotorinė apraksija, kaip ir amžius, funkcinė būklė, pažeistos kūno pusės neigimas, pažintinių funkcijų sutrikimai yra reikšmingai susijusi su insulto baigtimis (41). Kitos studijos tyrėjai padarė priešingą išvadą, kad apraksija neturi neigiamos įtakos pacientų, persirgusių insultu, funkcinės būklės atsigavimui (44).…”

“…Užsienio literatūros duomenimis, pažintinių funkcijų sutrikimai, turintys įtakos pacientų elgsenai ir kasdienei veiklai, gali riboti pacientų funkcinės būklės atsigavimą stacionarinės reabilitacijos laikotarpiu (4,6,32,41,(45)(46)(47), gali turėti įtakos stacionarinės reabilitacijos trukmei (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), savarankiškumui (6, 32, 47) ir gyvenimo kokybei (33) vėlesniu ligos laikotarpiu ir yra svarbūs veiksniai insulto baigtims numatyti (34).…”

Modelling activities of daily living applied to cognitive rehabilitation

“…Another study based on observation studies the correlation between ADL motor and cognitive impairments and apraxia scores revealed from standard clinical tests in ADL task, such as washing the face and upper body and putting on a blouse or shirt [33]. The study of the Functional Independent Measure score as an outcome variable has been demonstrated as a correlated index to foresight the effects of the severity for performing ADL, established in [34]. Other similar scale is provided by the Physical Self-Maintenance Scale (PSMS) [35].…”