Rehabilitation Outcomes of Patients with Severe Disability After Stroke

Publication date: Available online 26 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Domenico Scrutinio, Pietro Guida, Bernardo Lanzillo, Chiara Ferretti, Anna Loverre, Nicola Montrone, Simona Spaccavento

Abstract.

Objective

To characterize rehabilitation outcomes of patients with severe post-stroke motor impairment (MI) and develop a predictive model for treatment failure.

Design

Retrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI following rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model.

Setting

Three specialized inpatient rehabilitation facilities.

Participants

1,265 patients classified as Case-Mix Groups (CMG) 0108, 0109, and 0110 of the Medicare classification system.

Interventions

Not applicable.

Main Outcome Measure

Change in the severity of MI, as assessed by the Functional Independence Measure (FIM), from admission to discharge,

Results

Median FIM-motor score increased from 17 (Interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-motor effectiveness, was 26% (IQR, 12-47). Median FIM-motor change was 18 (IQR, 9-34) points. 38.5% patients achieved the Minimal Clinically Important Difference. 18.6% and 38.5% of the patients recovered to a stage of either mild (FIM-motor ≥62) or moderate (FIM-motor 38-to-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an AUC of 0.833 (95% CIs 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the "treat all" strategy.

Conclusions

This study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe post-stroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.

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