Predictors of long-term recovery in complex activities of daily living before discharge from the stroke unit.
OBJECTIVE
There is a need for individuating those post-stroke patients who may benefit from an optimal and customised rehabilitation plan aiming at early reintegration in community life participation. This study investigated whether the gain of independence in complex Activities of Daily Living (ADL) may be predicted before the discharge from the stroke unit using simple bedside determinants.


METHODS
In 104 first-ever stroke patients with no previous disability, ten determinants at 10 days after stroke were selected. Multivariable logistic regression analysis was applied to identify the prognostic determinants able to predict independence in complex ADL, as measured by modified Rankin Scale grade ≤2.


RESULTS
The model shows that having a Barthel Index ≥9, a Motricity Index- Upper Limb ≥75, an age ≤70 and being a male resulted in 100% probability of achieving independence in complex ADL. If three of the four determinants were present, the probability was more than 90%. With the presence of two of the four determinants, the probability ranged from 87% to 28%. With the presence of only one determinant, the probability was 13%.


CONCLUSIONS
Accurate prediction of independence in complex ADL can be made before the discharge from the stroke unit. The strength of the paretic upper limb, age, gender, and the ability of performing basic ADL are the significant variables. The probability of favorable prognosis depends on the presence and on the robustness of each single determinant.
U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Università di Siena, Siena, Italy Scuola di Dottorato in Scienze Cognitive, Azienda Ospedaliera Universitaria Senese, Università di Siena, Siena, Italy.
David
D
Cioncoloni
Giuseppe
G
Martini
Pietro
P
Piu
Sabrina
S
Taddei
Maurizio
M
Acampa
Francesca
F
Guideri
Rossana
R
Tassi
Riccardo
R
Mazzocchio
D000203:Activities of Daily Living; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation
Stroke; prognosis; recovery of function