The influence of comorbidities and complications on discharge function in stroke rehabilitation inpatients.
OBJECTIVE
The aims of this prospective study were: 1) to assess the frequency, type and severity of comorbidities (COMs) and complications (COMPLs) in acute stroke patients, according to the weighted comorbidity index (w-CI) of Liu et al. and 2 new indices, respectively COM severity index (COM-SI) and COMPL severity index (COMPL-SI); 2) to separately analyse the interference of COMs and COMPLs with functional status and recovery during stroke rehabilitation treatment; 3) to compare the ability of COM-SI and COMPL-SI to predict functional independence at discharge with that of w-CI.


METHODS
Eighty-five stroke rehabilitation inpatients participated in the study. The type, incidence and severity of COM at admission and of COMPL during the whole hospital stay were studied prospectively. The Functional Independence Measure (FIM) scale was administered at both admission and discharge.


RESULTS
About 1/3 suffered from some significant COM and another 1/3 developed COMPLs needing specific medical treatment and/or clinical monitoring. The most frequent COMs and COMPLs were cardiovascular and psychiatric/psychological diseases. The odds of having a high efficiency in the daily functional gain (FIM score) were greater for patients without any COM (3.5) and/or COMPL (4.6). Similarly, the odds of having a high FIM score at discharge were greater (3.5) for patients without COM or COMPL. The COM-SI demonstrated a higher predictive capacity of the FIM score at discharge (5%) than w-CI (4%), and COMPL-SI (1%).


CONCLUSIONS
COM-SI resulted as the most interesting predictive index of functional outcome at discharge, after accounting for the functional status at admission.
Ferriero
G
G
Unit of Occupational Rehabilitation and Ergonomics, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Veruno, Novara, Italy. gferriero@fsm.it
Franchignoni
F
F
Benevolo
E
E
Ottonello
M
M
Scocchi
M
M
Xanthi
M
M
D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation