Abstract
Objective
To characterize rehabilitation outcomes of patients with severe poststroke motor impairment
(MI) and develop a predictive model for treatment failure.
Design
Retrospective cohort study. Correlates of treatment failure, defined as the persistence
of severe MI after rehabilitation, were identified using logistic regression analysis.
Then, an integer-based scoring rule was developed from the logistic model.
Setting
Three specialized inpatient rehabilitation facilities.
Participants
Patients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the
Medicare classification system.
Interventions
Not applicable.
Main Outcome Measure
Change in the severity of MI, as assessed by the FIM, from admission to discharge.
Results
Median FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23)
to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness,
was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients
achieved the minimal clinically important difference. Eighteen point six percent and
32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate
(FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant.
Outcomes have also been analyzed according to classification systems used in Australia
and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence
interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using
the risk score compared with the treat all strategy.
Conclusions
This study provides a snapshot of rehabilitation outcomes in a large cohort of patients
with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately
identified the patients at risk for treatment failure.
Keywords
List of abbreviations:
AN-SNAP (Australian National Subacute and Non-acute Patient), AUC (area under the curve), CI (confidence interval), CMG (case-mix group), FIM-M (FIM-motor), IQR (interquartile range), IRF (inpatient rehabilitation facility), LOS (length of stay), MI (motor impairment), RPG (Rehabilitation Patient Group)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 26, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
