Functional Gain After Inpatient Stroke Rehabilitation

Once again failing to look at objective measures like size of dead and damaged area and the location to try to come up with predicted recovery. Rub a couple of neurons together and drop this fuckingly stupid subjective measurements.
http://stroke.ahajournals.org/content/early/2015/09/02/STROKEAHA.115.010440.abstract

Correlates and Impact on Long-Term Survival

1. Domenico Scrutinio, MD,
2. Vincenzo Monitillo, MD,
3. Pietro Guida, PhD,
4. Roberto Nardulli, MD,
5. Vincenzo Multari, MD,
6. Francesco Monitillo, MD,
7. Gianluigi Calabrese, MD and
8. Pietro Fiore, MD

+ Author Affiliations

1. From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, “S. Maugeri” Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).

1. Correspondence to Domenico Scrutinio, MD, Department of Cardiology and Cardiac Rehabilitation, Fondazione “S. Maugeri” IRCCS, 70020 Cassano Murge (Bari), Italy. E-mail domenico.scrutinio@fsm.it

Abstract

Background and Purpose—Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk.

Methods—The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality.

Results—Age (P<0.001), marital status (P=0.003), time from stroke onset to rehabilitation admission (P<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R² of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain.

Conclusions—Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR.