Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care.

Abstract

Background and PurposeThe most powerful predictors of functional recovery and eventual home discharge among stroke survivors are the initial severity of the stroke and the patient's age. We analyzed a large population of stroke rehabilitation admissions by stratifying subgroups with coherent outcomes in an attempt to define potentially more efficient patterns of providing rehabilitation care.Methods We retrospectively analyzed 520 consecutive patients admitted to a rehabilitation hospital (1 calendar year) with cerebral infarction or hemorrhage. Side of index stroke, age, and functional disability at admission were the independent variables. Change in functional disability and home versus nursing home discharge were the dependent measures.Results Recovery was overall most closely related to admission severity and age, but the relations between recovery and independent measures were complex. Patients aged <55 years all were discharged home whatever their initial severity.

Estudo comparativo entre a relação do hemisfério acometido no acidente vascular encefálico e a evolução funcional em indivíduos destros

“…In these studies, however, individuals were recruited in outpatient clinics, and as these patients generally demonstrate less severe sensory and motor deficits, the discrepancy in results may be attributed to the greater severity of deficits demonstrated by patients in the present study. The lower rate of recovery of gait in the group with left CVA also contrasts with reports of lower rates for individuals with right CVA compared to individuals with left CVA [23][24][25] . Since the magnitude of the injury was not controlled in other reported studies, it is possible that deficits in additional areas may be related to the differences in their results to the present study.…”

“…As expected, all assessed variables demonstrated improvements from the fi rst to the third month after the CVA. Th is observed functional recovery was related to the reversal of edema and biochemical alterations in the interstitial area of the injury 34 , as well as to the neural reorganization resulting from the demands of daily life and rehabilitation training 1,3,9,24,33 .…”

“…One study reported poorer recovery of postural stability while standing 20 and two other studies reported inferior recovery of the ability to sit without support and the presence of trunk compensations for stability in these patients 21,22 . Additionally, there are some studies describing inferior recovery of functional independency, as measured by the Barthel Index, in patients with right hemispheric injuries 23,24 , however, these reported diff erences were not observed in other studies 11,12 .…”

“…In fact, the lack of careful control of those variables in many studies indicates the need for cautious interpretation of their results. Care is even more important in face of the lack of control of hand dominance of the studied patients 5,9,10,14,21,23,24 , the exclusion of patients with dysphasia 22,24,25 and hemineglect 14 . Th ese procedures obviously limit the conclusions that can be drawn from the referred studies.…”

Differences in Outcome and Predictors Between Ischemic and Intracerebral Hemorrhage

“…17 This finding may be driven by previous reports indicating that patient's access to stroke rehabilitation facilities may be triaged on the basis of their functional or neurological status at days 5 to 7 after stroke. 18 In this study, patients with ICH were more likely to have lower Barthel index scores at day 7 than ischemic stroke. In addition to this, both groups had similar lengths of stay, implying similar duration of inpatient rehabilitation time.…”