TY - JOUR
T1 - Functional recovery following rehabilitation after hemorrhagic and ischemic stroke
AU - Kelly, Peter J.
AU - Furie, Karen L.
AU - Shafqat, Saad
AU - Rallis, Nikoletta
AU - Chang, Yuchiao
AU - Stein, Joel
N1 - Funding Information:
Supported by the Clinical Investigator Training Program, Harvard/MIT Health Sciences and Technology - Beth Israel Deaconess Medical Center, in collaboration with Pfizer Inc; the American Heart Association, New England Affiliate; a Clinical Scientist Development Award, the Doris Duke Charitable Foundation; a Junior Faculty Award, Hartford Foundation for Excellence in Geriatric Research; and the Arthur Merrill and the Esther U. Sharp Memorial Fund.
PY - 2003/7/1
Y1 - 2003/7/1
N2 - Objectives: To quantify recovery after rehabilitation therapy and to identify factors that predicted functional outcome in survivors of intracerebral hemorrhage (ICH) compared with cerebral infarction. Design: Retrospective study of consecutive ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year period. Setting: Free-standing urban rehabilitation hospital. Participants: A total of 1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral infarction, 193 with ICH). Interventions: Not applicable. Main Outcome Measures: Functional status was measured using the FIM™ instrument, recorded at admission and discharge. Recovery was quantified by the change in FIM total score (AFIM total score). Outcome measures were total discharge FIM score and ΔFIM total score. Univariate and multivariate analyses were performed. Results: Total admission FIM score was higher in patients with cerebral infarction than in patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score was present. Patients with ICH made a significantly greater recovery than those with cerebral infarction (AFIM total score, 28 vs 23.3; P=.002). On multivariate analysis, younger age, longer length of stay, and admission FIM cognitive subscore independently predicted total discharge FIM and ΔFFM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not AFIM total score. The ICH patients with the most severely disabling strokes had significantly greater recovery than cerebral infarction patients with stroke of similar severity. Conclusions: The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity. Initial severity of disability, age, and duration of therapy best predicted functional outcome after rehabilitation.
AB - Objectives: To quantify recovery after rehabilitation therapy and to identify factors that predicted functional outcome in survivors of intracerebral hemorrhage (ICH) compared with cerebral infarction. Design: Retrospective study of consecutive ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year period. Setting: Free-standing urban rehabilitation hospital. Participants: A total of 1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral infarction, 193 with ICH). Interventions: Not applicable. Main Outcome Measures: Functional status was measured using the FIM™ instrument, recorded at admission and discharge. Recovery was quantified by the change in FIM total score (AFIM total score). Outcome measures were total discharge FIM score and ΔFIM total score. Univariate and multivariate analyses were performed. Results: Total admission FIM score was higher in patients with cerebral infarction than in patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score was present. Patients with ICH made a significantly greater recovery than those with cerebral infarction (AFIM total score, 28 vs 23.3; P=.002). On multivariate analysis, younger age, longer length of stay, and admission FIM cognitive subscore independently predicted total discharge FIM and ΔFFM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not AFIM total score. The ICH patients with the most severely disabling strokes had significantly greater recovery than cerebral infarction patients with stroke of similar severity. Conclusions: The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity. Initial severity of disability, age, and duration of therapy best predicted functional outcome after rehabilitation.
KW - Cerebral hemorrhage
KW - Rehabilitation
KW - Stroke
KW - Treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=0037817686&partnerID=8YFLogxK
U2 - 10.1016/S0003-9993(03)00040-6
DO - 10.1016/S0003-9993(03)00040-6
M3 - Article
C2 - 12881818
AN - SCOPUS:0037817686
SN - 0003-9993
VL - 84
SP - 968
EP - 972
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 7
ER -