title: The aftermath of rehabilitation for patients with severe stroke.
abstract: OBJECTIVE
  The study evaluates the aftermath of stroke in patients with very severe disability after their first ever stroke and dismissed after rehabilitation.
  
  
  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".
authors.affiliation: Istituto di Cibernetica E.R. Caianiello-CNR, Via Campi Flegrei 34, c/o Comprensorio A. Olivetti-Edificio 70, I-80078 Pozzuoli (Na), Italy. g.nolfe@cib.na.cnr.it
authors.forename: G
authors.initials: G
authors.lastname: Nolfe
authors.forename: A M
authors.initials: AM
authors.lastname: D'Aniello
authors.forename: R
authors.initials: R
authors.lastname: Muscherà
authors.forename: S
authors.initials: S
authors.lastname: Giaquinto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation