Early recovery during stroke rehabilitation predicts the functional outcome at discharge: a retrospective clinical study

I consider all prediction research in stroke completely worthless. Recovery research is what survivors want. The only goal in stroke is 100% recovery.

 Early recovery during stroke rehabilitation predicts the functional outcome at
discharge: a retrospective clinical study

Authors

Marco Anziano1,*, Riccardo Cusinato2,3, Athina Tzovara2,3, Lucas Spierer1 , Joelle N. Chabwine1,4

Affiliations

1 Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine,

University of Fribourg, Fribourg, Switzerland.

2 Institute of Computer Science, University of Bern, Switzerland.

3 Center for Experimental Neurology - Sleep Wake Epilepsy Center - NeuroTec, Department of

Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.

4 Neurology Division, Internal Medicine Department, Fribourg Hospital, Fribourg, Switzerland.

*Corresponding author

Dr Marco Anziano,

Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine,

University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland

Email: marco.anziano @unifr.ch

ORCID: https://orcid.org/0000-0002-6235-9727

Authors contributions

MA: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration;

Validation; Writing - original draft; Writing - review & editing.

JNC and LS: Conceptualization; Funding acquisition; Methodology; Project administration; Supervision;

Writing - original draft; Writing - review & editing.

AT and RC: Formal analysis, Methodology.

Acknowledgments

This work was supported by a grant from the Swiss National Science Foundation to LS (#32513B_212616) and

AT (#320030_188737), as well as by the QuadriMed fund, and the Fondation Pierre Mercier pour la science.

We thank Franziska Peier and Naima Mory for their help in data collection and Fiona Chesnel for her help in

lesion processing.

Abstract

Background: Models predicting functional recovery upon stroke rehabilitation (SR) are not

implemented in clinical practice due to their complexity and limited power in patients with

moderate/severe deficits.

Objectives: To obtain preliminary evidence supporting the predictive value of a single

measure of early recovery on SR discharge functional status.

Methods: We tested simple predictive models based on the functional independence

measure (FIM) changes during the first three weeks of SR (3wFIMgain) in 81 patients with

moderate/severe impairment.

Results: Patients with poor or good 3wFIMgain featured similar admission impairment, rate

of complications, presence of aphasia or dominant-sided hemisyndrome, while poor early

recovery was associated with lesions to the left sensory-motor cortex, temporo-parietal

junction, and superior longitudinal fasciculus.

The 3wFIMgain effectively predicted the discharge FIM gain in patients with ≥ 6 weeks of

SR stay. Combined with the admission FIM, the 3wFIMgain improved a predictive model for

the discharge FIM.

Conclusions: The 3wFIMgain bears strong discharge prognostic value and synthetizes

complex information about the early recovery of stroke patients that cannot be described by

individual clinical predictors. Measures of early recovery might improve the power of models

and simplify them, thus favoring application in clinical practice. Future validation in

confirmatory studies is required.