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From The Rehabilitation Hospital of Rhode Island (Dr. Ween), N. Smithfield, RI; Braintree Hospital (Drs. Ween and Alexander), Braintree, MA; University Hospital (Dr. D'Esposito), Philadelphia, PA; and Miriam Hospital (Dr. Roberts), Providence, RI.
Presented in part at the 46th annual meeting of the American Academy of Neurology, Washington, DC, May 1994.
Received October 6, 1995. Accepted in final form February 9, 1996.
Address correspondence and reprint requests to Dr. Jon Erik Ween, Department of Neurology, Braintree Hospital, 250 Pond St., Braintree, MA 02184.
Accurate outcome prediction following stroke is important for proper delivery of poststroke care.It has been difficult to determine specific factors that provide reliable and accurate predictions of outcome, particularly for patients with intermediate deficit severities. Age and severity of deficit have repeatedly been found to be most reliable, but only as rough estimates and for patients at either extreme of the disability spectrum. This paper reports a prospective study of consecutive rehabilitation admissions (N = 536) to determine the influence of preselected factors. Outcome was analyzed in terms of functional improvement and disposition. Patients younger than 55 years or with an admission Functional Independence Measure (FIM) greater than 80 almost universally went home. Admission FIMs less than 40 were associated with nearly certain nursing home discharge. The comprehensive FIM score was a stronger predictor of outcome than motor impairment in isolation. An admission FIM of 60 or greater was associated with a higher probability of functional improvement during rehabilitation. Small-vessel strokes had the best outcome. Intracerebral hemorrhages improved more than ischemic strokes but more slowly. Right hemisphere lesions did worse than left. Comorbidities influenced outcome only when several conditions accumulated. The absence of a committed caregiver at home increased the risk of nursing home discharge. Suggestions for rehabilitation triage are given.
NEUROLOGY 1996;47: 388-392
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