Article
Functional recovery following rehabilitation after hemorrhagic and ischemic stroke1,

https://doi.org/10.1016/S0003-9993(03)00040-6Get rights and content

Abstract

Kelly PJ, Furie KL, Shafqat S, Rallis N, Chang Y, Stein J. Functional recovery following rehabilitation after hemorrhagic and ischemic stroke. Arch Phys Med Rehabil 2003;84:968–72.

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 (ΔFIM 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 (ΔFIM 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 ΔFIM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not ΔFIM 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.

Section snippets

Methods

Using electronic hospital admission and billing databases, we retrospectively identified all persons with a diagnosis of stroke who were consecutively admitted to Spaulding Rehabilitation Hospital (Boston, MA) between January 1, 1996 and December 31, 1999. All medical records were reviewed by a trained research assistant and stroke neurologist (PJK, SS), and relevant clinical, demographic, and FIM information was extracted. The stroke category (infarct, hemorrhage), stroke location

Patient sample

Baseline characteristics of the study sample are presented in table 1. A total of 1064 cases were identified that fulfilled inclusion criteria (871 with cerebral infarction, 193 with ICH; 545 women, 519 men). For both cerebral infarction and ICH subgroups, 85% of strokes in each category were located in the supratentorial compartment. Overall, the mean age was significantly lower (P<.001) and the mean rehabilitation hospital LOS significantly longer (P=.05) in the ICH subgroup compared with

Discussion

The present findings support and extend previous studies on functional outcome after ischemic and hemorrhagic stroke.5, 17, 22, 23, 24 The present study also provides new information on the degree of recovery in survivors of ICH, particularly those most severely affected by their stroke. Overall, when compared with patients with cerebral infarction, patients with ICH had more functional impairment at admission for inpatient rehabilitation therapy, made greater gains during rehabilitation, and

Conclusion

These results provide new information concerning the interaction between severity of functional impairment and stroke mechanism in determining recovery after stroke. Our findings may assist efforts to rationally triage specific subgroups of patients for different levels of rehabilitation therapy after acute hospital care.

References (30)

  • H.S. Jorgensen et al.

    Outcome and time course of recovery in stroke. Part IOutcome. The Copenhagen Stroke Study

    Arch Phys Med Rehabil

    (1995)
  • E.J. Roth et al.

    Impairment and disabilitytheir relation during stroke rehabilitation

    Arch Phys Med Rehabil

    (1998)
  • P.A. Wolf et al.

    Epidemiology of stroke

  • Stroke statistics

    (2000)
  • C.S. Kase et al.

    Intracerebral hemorrhage

  • S. Helweg-Larsen et al.

    Prognosis for patients treated conservatively for spontaneous intracerebral hematomas

    Stroke

    (1984)
  • H.S. Jorgensen et al.

    Intracerebral hemorrhage versus infarctionstroke severity, risk factors and prognosis

    Ann Neurol

    (1995)
  • C.L. Franke et al.

    Prognostic factors in patients with intracerebral haematoma

    J Neurol Neurosurg Psychiatry

    (1992)
  • G.J. Hankey et al.

    Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study

    Stroke

    (2000)
  • B.R. Chambers et al.

    Prognosis of acute stroke

    Neurology

    (1987)
  • H.A. Abu-Zeid et al.

    Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. Diagnostic types and descriptive variables

    Arch Neurol

    (1978)
  • B. Westling et al.

    Survival following stroke. A prospective population-based study of 438 hospitalized cases with prediction according to subtype, severity and age

    Acta Neurol Scand

    (1990)
  • J. Bamford et al.

    A prospective study of acute cerebrovascular disease in the communitythe Oxfordshire Community Stroke Project 1981–86. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage

    J Neurol Neurosurg Psychiatry

    (1990)
  • C.S. Anderson et al.

    Predicting survival for one year among different subtypes of stroke. Results from the Perth Community Stroke Study

    Stroke

    (1994)
  • D.B. Hier et al.

    Hypertensive putaminal hemorrhage

    Ann Neurol

    (1977)
  • Cited by (0)

    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.

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    View full text