Recovery Rates after Stroke and Their Impact on Outcome Prediction

Abstract

Current assessments do not provide reliable factors predictive of outcome from stroke for stroke survivors of intermediate age and severity of deficit. We sought to investigate whether early rate of functional improvement can facilitate prediction of functional outcome, length of stay, and disposition beyond that afforded by age and initial severity of deficit. Prospective study of consecutive admissions to acute rehabilitation (N = 244) with diagnosis of ischemic or hemorrhagic stroke. Independent measures were age, marital status, living situation, social situation, lag from symptom onset to rehabilitation, stroke type, admission score on the Functional Independence Measure (FIM), rate of FIM change (ROFC) as assessed by the best weekly FIM change in the first 3 weeks of rehabilitation. Dependent measures were functional status on discharge as assessed by a modification of Steinman's method, length of stay, and discharge disposition. Logistic regression analyses on each of the dependent measures identified significant factors, and interactions of significant factors were assessed by analysis of variance on continuous dependent variables. Cross-tabulations using significant factors from the logistic regression analyses were performed to identify groups with homogeneous outcomes. Groups with >80% homogeneity were considered likely to have predictive value. Discharge functional status: Admission FIM (AFIM) again fractionated the population into groups with poor outcome (AFIM <50 remained dependent), good outcome (AFIM >70 achieved nondependence), and an intermediate group with unpredictable outcome. In this intermediate group, ROFC had significant effect only for a small number of patients (n = 9) with rapid improvement (ROFC >25) who achieved nondependence. LOS: AFIM >70 had less than average LOS, ROFC = 10-15 FIM/week had longer than average LOS. LOS was significantly prolonged in patients with poor outcomes. Disposition: AFIM >70 and age <60 were strongly associated with home discharge. Patients not living at home before admission were not discharged home. Married patients had a greater tendency to home discharge than did those not married. ROFC had no bearing on disposition. ROFC has an independent influence on outcome but was sufficiently powerful in our sample to identify reliably only a very small subset of patients with otherwise indeterminate prognosis. LOS seems inordinately prolonged in patients with poor outcomes. Both of these results can guide efficient rehabilitation management.

Neuropsychological Profiles of 5-Year Ischemic Stroke Survivors by Oxfordshire Stroke Classification and Hemisphere of Lesion

“…16 Recent studies suggest refining lesion location is more predictive of cognitive impairment and recovery. 37 In associating outcomes and hemisphere of lesion, findings have varied with reports that right hemisphere lesions relate to poorer functional outcomes poststroke 11,12 and in rehabilitation units, 38 whereas others report no relationship. [13][14][15] Thus, hemisphere of lesion may not be a good predictor of recovery after stroke.…”

Post stroke disposition from a Geriatric-Rehabilitative Stroke Care Area: an Italian experience

“…According to literature, [4][5][6][7][9][10][11][12][13]19 the NIH-SS score on admission highly correlated to hospital disposition (P<0.0001). Among patients discharged home 76% had a NIH-SS score ≤5, 22% had NIH-SS score ≥6-13 and only 2% had a score >13.…”

“…[4][5][6][7][8][9] In France authors differentiate among four settings: home, rehabilitation, convalescent (temporary) home and long-term nursing home. 10 Main factors associated with post-stroke disposition are the severity of neurological deficit at the entrance, 4,7,8 age, LOS in stroke units, functional impairment of the upper arm and/or aphasia, 9 the level of disability at discharge, 11 incontinence, the need of feeding probe and cognitive impairment. 12 In a recent systematic review Hakkennes highlighted the most important indicators of disposition from a stroke unit [age, cognitive status, National Institute of Health Stroke Scale (NIH-SS) score, after stroke functional status and comorbidity] and the indicators of admission to rehabilitation (after stroke impairment, prestroke functional level and cognitive status).…”

Rehabilitation Programs monitored by Functional Independence Measure: An Observational Study

“…8 The admission FIM in patients after stroke (>70), together with several other variables, such as age (<60), being married and living at home prior stroke predicts whether the patients are discharged home. 9 Others indicate that a discharge FIM score of 80 or above had a high specificity and sensitivity with patients' discharge to their home. 10 Mokler et al 11 found that three admission FIM variables (bladder management, toilet transfers, memory) and three discharge FIM variables (upper body dressing, bed/chair tranfers, comprehension) were associated with discharge destination with up to 75% accuracy.…”