Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

Abstract

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Measure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diagnosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cognition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Conclusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

Validity of the SS-QOL in Germany and in Survivors of Hemorrhagic or Ischemic Stroke

“…34 With respect to the great proportion of survivors suffering a hemorrhagic stroke 35 in our study, it is important to recognize that ischemic and hemorrhagic stroke patients may have had different outcomes influenced by the severity of the disease. 36,37 This fact may limit the generalizability of the results. In respect to the factor analyses, it is important to keep in mind that the item-to-person ratio was not high, especially because the values of test-retest reliability are based on a small sample size and the true values may differ.…”

FIM Scores, FIM Efficiency, and Discharge Disposition Following Inpatient Stroke Rehabilitation

“…This group composes the largest population of stroke patients in many rehabilitation units (more than 50% on our unit). Nevertheless, little is known about the discharge disposition of this midrange group (Alexander, 1994; Black et al, 1999; Brosseau et al, 1996; Mauthe et al, 1996; Oczkowski & Barecca, 1993; Sandstrom et al, 1998; Schmidt & Dombovy, 1999; Ween et al, 1996; Werner, 1994). The results of this study suggest that the dispositions of patients with scores at the high and low ends of the FIM assessment are relatively predictable but that the planning for patients in the midrange group is more problematic.…”

“…This 126-point scale has a number of advantages: it is widely used, broad-based, simple to administer, well validated, and widely studied (Brosseau, Phillippe, Potvin, & Boulanger, 1996a, 1996bDodds, Martin, Stolov, & Deyo, 1993;Hajek, Gagnon, & Ruderman, 1997;Hamilton, Laughlin, Fiedler, & Granger, 1994;Ravaud, Delcey, Michel, & Yelni, 1999;Stineman et al, 1996). There is agreement in the literature that high and low scores correlate with outcome (Alexander , 1994;Black, Soltis, & Bartlett, 1999;Bohannon, Ahlquist, Lee, & Maljanian, 2003;Brosseau et al, 1996aBrosseau et al, , 1996bMauthe, Haff, Hayb, & Krall, 1996;Oczkowski & Bar ecca, 1993;Sandstrom et al, 1998;Schmidt & Dombovy, 1999;Ween, Alexander, D'Esposito, & Roberts, 1996;Ween, Memoff, & Alexander, 2000;Werner, 1994). In fact, patients with admission and discharge FIM scores >80 have a more than 90% probability of returning to their homes, while those with scores <40 have a 70% probability of being discharged to a skilled nursing facility.…”

“…However, there is a limited understanding of the predictive values of scores in the 40-79 midrange, although the literature indicates that patients with midrange scores have the greatest variability in discharge disposition (Alexander;Black et al;Brosseau et al, 1996;Mauthe et al;Oczkowski & Barecca;Sandstrom et al;Schmidt & Dombovy;Ween et al;Werner).…”

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

“…Patients with the most severe cognitive or physical impairments have been excluded from most rehabilitation trials, and therefore caution is required in extrapolating results to this group [579]. Limited data suggest that active rehabilitation allows severely disabled patients to return home [580, 581]. For those unable to participate actively, passive movements to prevent contractures or pressure sores have been recommended [2].…”