What fucking stupidity, predicting failure to recover. Rather that pointing out the protocols needed for 100% recovery. I want to hear your conversation with your patients when you tell then then they will still be dependent even after their rehab. Please explain how that won't be a complete failure on the doctor's part.
Influence of the amount of rehabilitation and the disease phase on recovering independence in patients with cerebral stroke
Abstract
Objective ‒ to determine independent predictors
and develop a prognostic model for asses-sing the likelihood of lack of
a good outcome (dependence) in cerebral stroke patients with severe
disabilities who were admitted to a comprehensive stroke unit in a
subacute or chronic phase.
Materials and methods. A
retrospective observational study enrolled patients with a verified
cerebral stroke, who were admitted to the Stroke Center (SC) over
2010‒2018 in the early subacute (from Day 8 to Day 90 from onset), the
late subacute (from Day 91 to Day 180 from onset) or chronic (after 180
days from onset) phase of the disease and had severe disabilities upon
admission (i.e. a modified Rankin scale (mRS) 4 or 5). There were
included 290 patients (38.7 % of women) aged from 20.4 to 91.2 years
(median ‒ 64.9 years, interquartile range ‒ 56.6‒74.6). Care in the SC
was provided in accordance with guidelines and included active
interdiscipli-nary rehabilitation. The restoration of independence in
daily living at discharge was considered a good outcome (mRS 0‒2). We
assessed the relationship of the risk of failure to achieve a good
outcome with five clinical variables: age, sex, stroke period, and
baseline mRS score and the amount (dose) of rehabilitation (total time
of physical therapy, ergotherapy or mechanotherapy).
Results.
81 (28.0 %) participant had intracerebral hemorrhage, whereas 209 (72.0
%) had cerebral infarction. The total National Institutes of Health
stroke scale (NIHSS) score on admission ranged from 1 to 36 (median 14
points, interquartile range 10–20). While 188 (64.8 %) of the patients
were hospitalized to the SC during the early subacute, 34 (11.8 %) and
68 (23.4 %) study participants were admitted only in the late subacute
and chronic phase of stroke, respectively. In the analysis of
generalized linear regression models, three features had a significant
relationship with a decrease in the mRS score: sex, time from stroke
onset to SC admission, and the total time of mechanotherapy. According
to the multivariate analysis, four factors were significantly associated
with a need for assistance in activities of daily living at SC
discharge: the risk of dependence was significantly (p = 0.004) lower in
men, was directly depended on the initial mRS score and the time
elapsed from the estimated stroke onset to the SC admission, but was
inversely related to the amount (dose) of certain rehabilitation
interventions (the odds ratio of not achieving a good outcome was 0.93
(95 % CI 0.89‒0.97) for every additional 100 minutes of mechanotherapy).
The logistic regression model based on the selected set of features
turned out to be adequate (χ2 = 60.7 at 7 degrees of freedom, p
<0.001). The area under the curve of operational characteristics AUC =
0.82 (95 % CI 0.77‒0.86) indicates good internal prognostic model
agreement, and its sensitivity and specificity were good with 76.1 % (95
% CI 70.1‒81.4 %) and 75.0 % (95 % CI 61.6‒85.6 %), respectively.
Conclusions.
In a cohort of patients with cerebral stroke, independent predictors of
dependency after in-patient rehabilitation were identified and a
predictive model was developed to assess the likelihood of a good
treatment outcome. If its external validity is confirmed in other
settings, the developed model may be useful for optimizing treatment
strategies and providing patients and their families with prognostic
evaluations.
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