Article

OBJECTIVE: To develop a prognostic index using Functional Independence Measure
grades and stages that would enable clinicians to determine the likelihood of
achieving a level of minimum assistance with physical functioning after a stroke.
Grades define varying levels of physical function, and stages define varying
levels of cognitive functioning. DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Medical Centers throughout the United States. PARTICIPANTS: Veterans with a diagnosis of a new stroke discharged between October 1, 2006, and
September 30, 2008, who were below physical grade IV (requiring minimal
assistance) at initial rehabilitation assessment. MAIN OUTCOME MEASURE:
Achievement of physical grade IV or above at final rehabilitation assessment.
RESULTS: Physical grade IV was reached by 25.8% of participants who were
initially below this grade. Seven variables remained independently predictive of
physical grade IV after adjustment. These variables were assigned the following
points: age, /=80 years = 0; initial physical
grade, I = 0, II = 3, III = 4; initial cognitive stage, I or II = 0, III = 2, IV
or V = 3, VI or VII = 4; absence of renal failure = 1; no serious nutritional
compromise = 3; the type of rehabilitation services received, consultative = 0,
comprehensive = 4; and recovery time between admission and discharge physical
grade assessment, 1-2 days = 0, 3-7 days = 4, and >/=8 days = 5. The area under
the receiver operating characteristic curve was 0.84 and 0.83 for the point
system in the derivation and validation cohorts, respectively. The
Hosmer-Lemeshow statistic was not significant (P = .93) in the derivation cohort,
indicating that the regression model demonstrated adequate fit. The proportions
of patients recovered to physical grade IV in the first (score >/=9), second
(score = 10-12), third (score = 13-15), and fourth (score >15) score quartiles
were 2.72%, 11.38%, 28.96%, and 60.34%, respectively. CONCLUSION: By using a
simple tool, clinicians can forecast the likelihood of recovery to or above the
physical grade IV benchmark by the conclusion of rehabilitation services during
the acute stroke hospitalization.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc.
All rights reserved.

Langue : ANGLAIS