Functional Outcomes after Inpatient Rehabilitation in a Prospective Stroke Cohort

Abstract

Aim: Rehabilitation is proven to improve function following a stroke. The functional outcomes of stroke patients and benefits from rehabilitation are highly variable. We aim to describe functional outcomes and gains following inpatient rehabilitation post-stroke and identify factors associated with improved outcomes. Methods: In this five-years prospective study, data for 1332 consecutive stroke patients admitted to the Singapore General Hospital inpatient rehabilitation unit were charted into a custom-designed rehabilitation database. The primary outcome measure was the Functional Independence Measure (AFIM) and discharge (DFIM). The functional gain was defined as the DFIM-AFIM. Results: The mean age was 64.1±12.5 years, 58.9% were male patients and 78.9% consisted of ischaemic (versus haemorrhagic) strokes. The average rehabilitation length of stay (RLOS) was 18.7±13.9 days and the majority (87.7%) were discharged home. The most common risk factor was hypertension (78.4%) and urinary tract infection (21.2%) was the commonest post-stroke complication. The mean AFIM and DFIM scores were 67.9±23.0 and 83.2±23.5 respectively with a mean functional gain of 15.4±12.3 FIM points. Younger, male, and haemorrhagic stroke patients had better functional outcomes. Multiple regression analysis results revealed that higher DFIM score was associated with higher admission motor and cognitive FIM scores, younger age, male gender, employment at admission, single patients, presence of a caregiver, haemorrhagic stroke, right-sided motor impairments, absence of urinary tract infection or depression, acupunction treatment, and a longer RLOS. The regression model on functional gain was associated with similar independent predictors on DFIM scores except that a higher AFIM was associated with lower functional gains. Conclusion: In this large cohort study, stroke patients make significant functional gains and should be offered rehabilitation to improve outcomes. A comprehensive set of multiple interacting demographic, clinical, cultural, and social factors significanctly impact on stroke functional outcomes after inpatient rehabilitation. The identification of these factors allows optimising rehabilitation for individual patients, and is important for discharge and resource planning.

The Effect of Candesartan Pre-Stroke Use on the Functional Outcome of Post Ischemic Stroke Patients in Bethesda Hospital Yogyakarta

“…The results of this study indicated that the male patients had lower functional outcome probability than female patients. This contrasted to the Ng et al (2013) who stated that female patients had worse post-stroke physical ability than male patients who were able to do physical activity independently (HR: 0.51, 95%CI:0.32-0.79). The researcher stated that the pre-stroke physical function and the symptoms of depression were important factors in the different results of the both gender recovery (Ng et al, 2013).…”

Use of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) in an early supported discharge programme for stroke patients in Singapore

“…According to Haigh et al (2001), numerous assessment tools have been used to measure therapy outcomes for stroke, such as the Functional Independence Measure (FIM) (Dodds et al, 1993), the Barthel Index (Mahoney and Barthel, 1965), the Rivermead Behavioural Memory Test (Collen et al, 1991) and the Medical Outcomes Study Short Form General Health Survey (SF-36) (Ware and Sherbourne, 1992). In Singapore, the FIM and the Modified Barthel Index (Shah et al, 1989) are commonly used as outcome measures for the stroke population (Chua and Kong, 1996;Ng et al, 2013). However, these scales only measure a certain domain of performance in relation to activity limitation (Unsworth, 2005).…”

A Portable Soft Hand Exerciser With Variable Elastic Resistance for Rehabilitation and Strengthening of Finger, Wrist, and Hand1

“…The recovery and rehabilitation process, if not well-managed, can lead to aftereffects which will impact on the quality of lives of the patients and their families. It was reported that early rehabilitation management after acute stroke leads to better outcomes and shorter hospitalization stays [3].…”