title: Development and Validation of Prognostic Indices for Recovery of Physical Functioning Following Stroke: Part 2.
abstract: OBJECTIVE
  To develop a prognostic index for achievement of modified independence (Functional Independence Measure grade VI) after completion of either comprehensive or consultative rehabilitation after stroke.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs Medical Centers (VAMCs) throughout the United States.
  
  
  METHODS
  Data included 5316 patients with stroke discharged from VAMCs who received rehabilitation services while hospitalized and who were physically dependent at initial assessment. The index was derived with use of 60% of the sample and validated in the remaining 40% of the sample. Points derived from the β coefficients of a multivariable logistic model were added to scores that were associated with the probability of recovery.
  
  
  METHODS
  Recovery to modified independence or above at final rehabilitation assessment, defined as when patients no longer need physical assistance with eating; grooming; dressing the upper and lower body; toileting; sphincter management; bed to chair, toilet, and tub transfers; and walking/wheelchair use and when they require no more than supervision with bathing or climbing stairs.
  
  
  RESULTS
  Seven independent predictors were identified through logistic regression in the derivation sample: initial physical grade (I or II = 0 points; III = 2 points; IV = 4 points; V = 5 points), initial cognitive stage (I or II = 0 points; III = 2 points; IV = 3 points, V or VI = 4 points; VII =5 points), type of rehabilitation (consultative = 0 points; comprehensive = 4 points), age (<60 years = 3 points; 60-79 years = 2 points; ≥80 years = 0 points), time from initial to final physical grade assessment (1-2 days = 0 points; ≥3 days = 2 points), absence of urinary procedures (3 points), and absence of diabetes with complications (1 point). The following proportions of patients recovered to physical grade VI for the first, second, third, and fourth quartile scores, respectively: 0.59% (score ≤9), 3.87% (score = 9-11), 14.19% (score = 12-15), and 37.38% (score ≥16).
  
  
  CONCLUSIONS
  Functional recovery to physical grade VI can be predicted on the basis of patients' initial status after a stroke occurs and the type of rehabilitation services to be provided by using a simple scoring system.
authors: Physical Medicine and Rehabilitation, Samuel S. Stratton Veterans Affairs Medical Center, 113 Holland Ave, Albany, NY 12208.|Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY.
authors: Barbara E
authors: BE
authors: Bates
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Dawei
authors: D
authors: Xie
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Pui L
authors: PL
authors: Kwong
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors: Jibby E
authors: JE
authors: Kurichi
authors: VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors: Diane Cowper
authors: DC
authors: Ripley
authors: Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY.
authors: Claire
authors: C
authors: Davenport
authors: VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.|Department of Health Outcomes and Policy, University of Florida, College of Medicine, Gainesville, FL.
authors: W Bruce
authors: WB
authors: Vogel
authors: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.|Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
authors: Margaret G
authors: MG
authors: Stineman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D026741:Physical Therapy Modalities; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation