title: Development and Validation of Prognostic Indices for Recovery of Physical Functioning Following Stroke: Part 1.
abstract: OBJECTIVE
  To develop a prognostic index using Functional Independence Measure grades and stages that would enable clinicians to determine the likelihood of achieving a level of minimum assistance with physical functioning after a stroke. Grades define varying levels of physical function, and stages define varying levels of cognitive functioning.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs Medical Centers throughout the United States.
  
  
  METHODS
  Veterans with a diagnosis of a new stroke discharged between October 1, 2006, and September 30, 2008, who were below physical grade IV (requiring minimal assistance) at initial rehabilitation assessment.
  
  
  METHODS
  Achievement of physical grade IV or above at final rehabilitation assessment.
  
  
  RESULTS
  Physical grade IV was reached by 25.8% of participants who were initially below this grade. Seven variables remained independently predictive of physical grade IV after adjustment. These variables were assigned the following points: age, ≤69 years = 2, 70-79 years = 1, ≥80 years = 0; initial physical grade, I = 0, II = 3, III = 4; initial cognitive stage, I or II = 0, III = 2, IV or V = 3, VI or VII = 4; absence of renal failure = 1; no serious nutritional compromise = 3; the type of rehabilitation services received, consultative = 0, comprehensive = 4; and recovery time between admission and discharge physical grade assessment, 1-2 days = 0, 3-7 days = 4, and ≥8 days = 5. The area under the receiver operating characteristic curve was 0.84 and 0.83 for the point system in the derivation and validation cohorts, respectively. The Hosmer-Lemeshow statistic was not significant (P = .93) in the derivation cohort, indicating that the regression model demonstrated adequate fit. The proportions of patients recovered to physical grade IV in the first (score ≥9), second (score = 10-12), third (score = 13-15), and fourth (score >15) score quartiles were 2.72%, 11.38%, 28.96%, and 60.34%, respectively.
  
  
  CONCLUSIONS
  By using a simple tool, clinicians can forecast the likelihood of recovery to or above the physical grade IV benchmark by the conclusion of rehabilitation services during the acute stroke hospitalization.
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
authors: D
authors: Cowper 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: D000203:Activities of Daily Living; 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