Functional Outcome in Stroke Inpatient Rehabilitation: Predicting No, Low and High Response Patients

Abstract

The aims of this study were: (1) to identify reliable prognostic factors for detecting subgroups of no, low and high response in consecutive patients admitted for rehabilitation of first stroke sequelae, and (2) to quantify the relative risk of poor or excellent prognosis on both Activities of Daily Living (ADL) and mobility for each significant variable. We prospectively studied 440 of 475 patients. From a group of 32 independent variables, those significantly associated with no, low and high effectiveness on both ADL and mobility were selected by means of multiple regression; then, the relative risk was calculated for each variable that significantly entered the multiple regressions. Patients with severe impairment or with global aphasia showed a relative risk of no response 4–6 times higher than that of other patients. An interval before rehabilitation longer than 2 months was associated with an increasing risk of no response. Elderly patients had a significantly higher relative risk of low response both on ADL and mobility. The presence of hemineglect and depression was associated with an increasing risk of low response on ADL but not on mobility. The absence of hemineglect and a short interval are prerequisites for an excellent functional prognosis on both ADL and mobility. A minor impairment, employed status, the absence of global aphasia and age ≤65 years increased the risk of high response. At the beginning of treatment, clear prognostic factors for the detection of subgroups with poor or excellent rehabilitation prognosis can be identified.

Neuropsychological Profiles of 5-Year Ischemic Stroke Survivors by Oxfordshire Stroke Classification and Hemisphere of Lesion

“…37 In associating outcomes and hemisphere of lesion, findings have varied with reports that right hemisphere lesions relate to poorer functional outcomes poststroke 11,12 and in rehabilitation units, 38 whereas others report no relationship. [13][14][15] Thus, hemisphere of lesion may not be a good predictor of recovery after stroke.…”

“…4,7,10 Research analyzing outcomes in relation to hemisphere of lesion vary; some studies report that right hemisphere lesions relate to poorer functional outcomes, 11,12 whereas others report no relationship. [13][14][15] Interestingly, studies examining cognitive outcomes after stroke have focused almost entirely on hemisphere of lesion. Generally those with left-side lesions show language and speech disorders, whereas those with right-side lesions show predominantly perceptual and visuospatial deficits.…”

Prognosis of aphasia in stroke patients early after iv thrombolysis

“…Patients with aphasia often remain disabled despite low baseline NIHSS scores [5]. These patients are increasingly treated with thrombolysis.…”

Motor and Functional Recovery After Stroke

“…The end point was 6 months after stroke as most motor and functional recovery takes place before that time. To enable adjustment for case-mix, several variables were documented based on previous studies of prognostic factors for motor 9 and functional recovery. 6 -8 Age, 6 -9 gender, 8 time between stroke onset and admission assessment, prestroke disability 8 (assessed by BI), type of stroke, side of impairment, urinary incontinence, 6 -8 and swallowing problems 6,7 were recorded on admission.…”

“…6 -9 Age, aphasia and initial impairment have been associated with motor recovery. 9 Tilling et al 8 found that the functional recovery of patients admitted for rehabilitation was predicted by urinary incontinence, sex, prestroke disability, dysarthria, age, dysphasia, and limb deficit.…”