Measurement of Outcomes of Care for Stroke Patients

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Results-The sample included 148 367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r 2 =0.107). No important additional effect for any other variable was detected when added to this model. Conclusions-This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set.

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10] Many of these reports are limited by small sample sizes and single-center reviews, considering a restricted number of predictive variables.…”

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confidence: 99%

Measure of Functional Independence Dominates Discharge Outcome Prediction After Inpatient Rehabilitation for Stroke

Brown

Therneau

Schultz

et al. 2015

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“…The Barthel Index can also be divided to measure the discrete functions of self-care ability (0-53 points) or mobility (0-47 points). 27 The Barthel Index has predictive validity in terms of survival, 28 29 and has a test-retest reliability of 0.89 and an interrater reliability of 0.95. 32 At the 5-week follow-up only, we assessed each surviving patient's behavioral and functional performance with the Level of Rehabilitation Scale (LORS), 33 which contains five domains: ADL, cognition, home activities, outside activities, and social interaction, each of which creates its own subscale.…”

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confidence: 99%

Examining outcome measures in a clinical study of stroke.

Wood-Dauphinée

Williams

Shapiro

1990

100

We investigated the relation between outcome and sample size for six selected stroke outcome measures to assist investigators in selecting end points for stroke studies. Data from a clinical trial of 167 stroke patients assessed shortly after admission to the hospital and 5 weeks later provided information on clinical, motor, and functional outcomes measured using a neurologic status scale, a stroke severity scale, the Fugl-Meyer Scale, the Barthel Index, and the activities of daily living and cognition subscales of the Level of Rehabilitation Scale. Data were examined using Pearson correlation coefficients and power analyses. All measures were significantly correlated. There was also substantial congruency between the subscales of a measure and its total score. The measures had variable efficiencies; the Barthel Index was the most efficient and therefore required the fewest subjects to identify a significant effect. These data suggest that careful consideration must be given to the choice of stroke outcome measures in terms of their numbers, interrelationships, and statistical properties, as these factors have important implications for the design, analysis, and conduct of clinical stroke studies. (Stroke 1990:21:731-739)

“…1 " 11 Lehmann et al 2 have presented a costbenefit analysis which shows that a "substantial savings resulted from rehabilitating the (stroke) patients. "…”

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confidence: 99%

Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 1. Analysis of 248 unscreened patients--medical and functional prognostic indicators.

Feigenson¹,

McDowell²,

Meese³

et al. 1977

216

SUMMARY A retrospective analysis of 248 patients with stroke (average age 67, range 17-98) admitted to a stroke rehabilitation unit over a sixteen month period showed that 80% of these patients were able to return home after an average length of stay (LOS) of 43 days. At discharge 85% of the group were ambulatory and 56% required no help in daily living activities. Severity of weakness on admission, long onsetadmission intervals, the presence of severe perceptual or cognitive dysfunction or a homonymous hemianopsia in addition to a motor deficit were related to unfavorable outcome and increased LOS. The age of the patient, dysphasia or a hemisensory deficit in addition to weakness, or diabetes, hypertension, or ASHD were unrelated to the patients' functional status on discharge, discharge disposition, or LOS. Many patients with "unfavorable prognostic signs" made significant improvement after admission and were subsequently discharged. Thus, while the above findings may predict which patients can make maximal gains in a short term treatment facility, they also show that most patients, even those with "poor prognostic signs," can make enough functional improvement to be managed at home after a relatively short hospitalization.