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Development and Validation of Prognostic Indices for Recovery of Physical Functioning Following Stroke: Part 2
Author(s) -
Bates Barbara E.,
Xie Dawei,
Kwong Pui L.,
Kurichi Jibby E.,
Ripley Diane Cowper,
Davenport Claire,
Vogel W. Bruce,
Stineman Margaret G.
Publication year - 2015
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2015.01.012
Subject(s) - medicine , physical therapy , toileting , rehabilitation , logistic regression , stroke (engine) , bathing , body mass index , activities of daily living , physical medicine and rehabilitation , mechanical engineering , pathology , engineering
Objective To develop a prognostic index for achievement of modified independence (Functional Independence Measure grade VI) after completion of either comprehensive or consultative rehabilitation after stroke. Design Retrospective cohort study. Setting Veterans Affairs Medical Centers (VAMCs) throughout the United States. Participants Data included 5316 patients with stroke discharged from VAMCs who received rehabilitation services while hospitalized and who were physically dependent at initial assessment. The index was derived with use of 60% of the sample and validated in the remaining 40% of the sample. Points derived from the β coefficients of a multivariable logistic model were added to scores that were associated with the probability of recovery. Main Outcome Measure Recovery to modified independence or above at final rehabilitation assessment, defined as when patients no longer need physical assistance with eating; grooming; dressing the upper and lower body; toileting; sphincter management; bed to chair, toilet, and tub transfers; and walking/wheelchair use and when they require no more than supervision with bathing or climbing stairs. Results Seven independent predictors were identified through logistic regression in the derivation sample: initial physical grade (I or II = 0 points; III = 2 points; IV = 4 points; V = 5 points), initial cognitive stage (I or II = 0 points; III = 2 points; IV = 3 points, V or VI = 4 points; VII =5 points), type of rehabilitation (consultative = 0 points; comprehensive = 4 points), age (<60 years = 3 points; 60‐79 years = 2 points; ≥80 years = 0 points), time from initial to final physical grade assessment (1‐2 days = 0 points; ≥3 days = 2 points), absence of urinary procedures (3 points), and absence of diabetes with complications (1 point). The following proportions of patients recovered to physical grade VI for the first, second, third, and fourth quartile scores, respectively: 0.59% (score ≤9), 3.87% (score = 9‐11), 14.19% (score = 12‐15), and 37.38% (score ≥16). Conclusion Functional recovery to physical grade VI can be predicted on the basis of patients' initial status after a stroke occurs and the type of rehabilitation services to be provided by using a simple scoring system.