Article

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 beta 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
/=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.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS