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The aftermath of rehabilitation for patients with severe stroke
Author(s) -
Nolfe G.,
D'Aniello A. M.,
Muscherà R.,
Giaquinto S.
Publication year - 2003
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1034/j.1600-0404.2003.02022.x
Subject(s) - rehabilitation , stroke (engine) , functional independence measure , medicine , activities of daily living , physical therapy , quartile , multivariate analysis , stroke recovery , physical medicine and rehabilitation , confidence interval , mechanical engineering , engineering
Objective – The study evaluates the aftermath of stroke in patients with very severe disability after their first ever stroke and dismissed after rehabilitation. Materials and methods – Sixty‐nine inpatients were studied, who were highly disabled at discharge with a Functional Independence Measure (FIM) score in the range of 18–39. Their rehabilitation program had lasted 60 days. The degree of functional independence was measured by means of the FIM at the beginning of treatment, at discharge and at follow‐up. The data collected were examined by using parametric and distribution‐free statistical methods. The role of age in the process of recovery was also evaluated. Results – All patients were discharged home after 2 months. At 6 month follow‐up, 15 patients (21.7%) were lost, 27 (39.1%) had died and 27 (39.1%) lived at home. Among stroke survivors a clear trend toward an improvement was detected during the 6 months observation period. Indeed, the third quartile changed from 33 to 63 and a patient approached to independence (FIM 87). None underwent a rehabilitation program at home beside the relatives' assistance. Conclusions – Highly disabled stroke patients are probably to undergo unfavourable outcome but unexpected recovery cannot be ruled‐out on the basis of cut‐off parameters measured after the acute phase of stroke. Multivariate statistical methods can identify factors which can interfere with functional recovery but are error‐prone in setting individual prognosis. Moreover the recovery process may develop in a long period of time. Taking into consideration the spontaneous recovery observed during the follow‐up period after the dismissal from rehabilitation ward, a suitable rehabilitation at home might be fruitful in these patients, who should not be considered as “lost”.