Functional recovery following rehabilitation after hemorrhagic and ischemic stroke.
OBJECTIVE
To quantify recovery after rehabilitation therapy and to identify factors that predicted functional outcome in survivors of intracerebral hemorrhage (ICH) compared with cerebral infarction.


METHODS
Retrospective study of consecutive ICH and cerebral infarction admissions to a rehabilitation hospital over a 4-year period.


METHODS
Free-standing urban rehabilitation hospital.


METHODS
A total of 1064 cases met the inclusion criteria (545 women, 519 men; 871 with cerebral infarction, 193 with ICH).


METHODS
Not applicable.


METHODS
Functional status was measured using the FIM trade mark instrument, recorded at admission and discharge. Recovery was quantified by the change in FIM total score (DeltaFIM total score). Outcome measures were total discharge FIM score and DeltaFIM total score. Univariate and multivariate analyses were performed.


RESULTS
Total admission FIM score was higher in patients with cerebral infarction than in patients with ICH (59 vs 51, P=.0001). No difference in total discharge FIM score was present. Patients with ICH made a significantly greater recovery than those with cerebral infarction (DeltaFIM total score, 28 vs 23.3; P=.002). On multivariate analysis, younger age, longer length of stay, and admission FIM cognitive subscore independently predicted total discharge FIM and DeltaFIM total score. The severity of disability at admission, indicated by total admission FIM score, independently predicted total discharge FIM score, but not DeltaFIM total score. The ICH patients with the most severely disabling strokes had significantly greater recovery than cerebral infarction patients with stroke of similar severity.


CONCLUSIONS
The patients with ICH had greater functional impairment than the cerebral infarction patients at admission, but made greater gains. Patients with the most severely disabling ICH improved more than those with cerebral infarction of comparable severity. Initial severity of disability, age, and duration of therapy best predicted functional outcome after rehabilitation.
Kelly
Peter J
PJ
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.
Furie
Karen L
KL
Shafqat
Saad
S
Rallis
Nikoletta
N
Chang
Yuchiao
Y
Stein
Joel
J
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D001900:Boston; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis; D002544:Cerebral Infarction / Q000150:complications* / Q000175:diagnosis; D015986:Confounding Factors, Epidemiologic; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014057:Tomography, X-Ray Computed