Stroke, Vol 25, 128-134, Copyright © 1994 by American Heart Association
MP Alexander
BACKGROUND AND PURPOSE--The most powerful predictors of functional recovery
and eventual home discharge among stroke survivors are the initial severity
of the stroke and the patient's age. We analyzed a large population of
stroke rehabilitation admissions by stratifying subgroups with coherent
outcomes in an attempt to define potentially more efficient patterns of
providing rehabilitation care. METHODS--We retrospectively analyzed 520
consecutive patients admitted to a rehabilitation hospital (1 calendar
year) with cerebral infarction or hemorrhage. Side of index stroke, age,
and functional disability at admission were the independent variables.
Change in functional disability and home versus nursing home discharge were
the dependent measures. RESULTS--Recovery was overall most closely related
to admission severity and age, but the relations between recovery and
independent measures were complex. Patients aged < 55 years all were
discharged home whatever their initial severity. Patients admitted with
modest functional disability were almost all discharged home (96%),
whatever their age. For the remainder of the patients, admission severity
and age interacted to create two groups with very different prospects for
home discharge (P < .0001). Within the groups that eventually returned
home, there were very different rates of functional improvement that were
directly related to length of hospital stay. CONCLUSIONS--Standard clinical
measures available at rehabilitation admission carry enough predictive
power to define management strategies for stroke survivors. A management
algorithm is proposed that might increase the efficiency of stroke
rehabilitation programs and might allow comparisons of efficacy between
different treatment settings.
ARTICLES
Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care
Braintree Rehabilitation Hospital, MA 02184.
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