Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study

 What blithering idiots approved this research rather than directing research to get to 100% recovery? Survivors don't want your stupid predictions of failure to recover.  This is proof of the absolute stupidity of the stroke medical world!

Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study

• Yen-Nung Lin, MS, MD
• Phan Van Sang, MD
• Valeria Chiu, MD
• Jiunn-Horng Kang, MD, PhD
• Tsan-Hon Liou, MD, PhD
• Pengsheng Ni, MD, PhD
• Feng-Hang Chang, ScD
• Show less

Published:October 03, 2023 

DOI:https://doi.org/10.1016/j.apmr.2023.09.016

https://doi.org/10.1016/j.apmr.2023.09.016Get rights and content

Abstract

Objective

To identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) following discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement.

Design

A longitudinal, multicenter, prospective cohort study.

Setting

The acute care wards of 3 hospitals in the Greater Taipei area of Taiwan.

Participants

Five hundred patients with stroke in acute care wards (mean age = 60 ± 12.2 years, 62% men).

Interventions

Not applicable.

Main Outcome Measure(s)

The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points.

Results

The mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (4%-26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22%-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P < .05). Patients with a higher functional stage at discharge were more likely to experience significant improvement.

Conclusion

This study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.

Introduction

Stroke is a major health problem globally and the leading cause of disability.¹ Every year, approximately 13.7 million individuals worldwide experience their first stroke.² In Taiwan, approximately 230 cases of stroke occur every day.³ This has led to an increased demand for medical care and rehabilitation for stroke that poses a substantial burden on the health-care system and society.¹

Prediction of functional recovery is critical for the rehabilitation of patients with stroke.⁴ Many studies have explored the trajectory of functional recovery following stroke.^4-8 A study indicated that the most significant recovery typically occurs during the first year, with the first few months being particularly important, following an acute episode.⁶ However, no consensus has been reached on the period during which substantial functional gains occur.⁵ Furthermore, most studies have adopted traditional instruments, such as the Barthel Index (BI)⁹ and Functional Independence Measure (FIM),¹⁰ to measure functional recovery and evaluate changes in functional outcomes in patients with stroke. However, the limitations of these instruments, including their ceiling effects and poor responsiveness, particularly for patients with chronic stroke, increase the difficulty of detecting meaningful changes across time and settings.^{6, 11}

Numerous studies have identified prognostic indicators for predicting poststroke functional outcomes. Age,^12-14 sex,^{14, 15} living alone or with family,¹⁶ depression,^{14, 17} aphasia,^{18, 19} neglect,^{18, 19} physical activity,²⁰ cognitive function,^{21, 22} stroke severity,^{23, 24} comorbidities,^{25, 26} stroke history,²⁷ and neurological status²⁷ have been identified as potential predictors of functional outcomes at 3 months, 6 months, and 1 year following stroke. However, only a few studies have determined the predictors of changes in functional outcomes across multiple time points, and most of these studies have focused on a specific functional domain (e.g., motor function).^{8, 28, 29} Whether and how functional improvement can be predicted during the early stages of rehabilitation remains unclear. Therefore, studies focusing on the early prediction of meaningful long-term changes in different functional domains following acute stroke rehabilitation are warranted.

This study identified meaningful functional changes that occur in patients with stroke during the first year following discharge (DC) from acute care wards in Taiwan by using an adequately sensitive outcome measure, the Activity Measure for Post-Acute Care (AM-PAC),³⁰ and identified the predictors at DC that can predict patient improvement in 3 functional domains, namely basic mobility (BM), daily activity (DA), and applied cognition (AC), from DC to 3 months (early-stage recovery), 3 to 6 months (middle-stage recovery), and 6 to 12 months (late-stage recovery).

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