Functional Gain After Inpatient Stroke Rehabilitation: Correlates and Impact on Long-Term Survival.
OBJECTIVE
Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk.


METHODS
The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality.


RESULTS
Age (P<0.001), marital status (P=0.003), time from stroke onset to rehabilitation admission (P<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R2 of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain.


CONCLUSIONS
Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR.
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.). domenico.scrutinio@fsm.it.
Domenico
D
Scrutinio
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Vincenzo
V
Monitillo
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Pietro
P
Guida
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Roberto
R
Nardulli
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Vincenzo
V
Multari
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Francesco
F
Monitillo
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Gianluigi
G
Calabrese
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Pietro
P
Fiore
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D000071939:Stroke Rehabilitation; D017741:Survivors; D016896:Treatment Outcome
D002784:Cholesterol
mortality; prognosis; regression analysis; rehabilitation; stroke