FACTORS PREDICTIVE OF STROKE OUTCOME IN A REHABILITATION SETTING

Accurate outcome prediction following stroke is important for proper d elivery of poststroke care. It has been difficult to determine specifi c factors that provide reliable and accurate predictions of outcome, p articularly for patients with intermediate deficit severities. Age and severity of deficit have repeatedly been found to be most reliable, b ut only as rough estimates and for patients at either extreme of the d isability spectrum. This paper reports a prospective study of consecut ive rehabilitation admissions (N = 536) to determine the influence of preselected factors. Outcome was analyzed in terms of functional impro vement and disposition. Patients younger than 55 years or with an admi ssion Functional Independence Measure (FIM) greater than 80 almost uni versally went home. Admission FIMs less than 40 were associated with n early certain nursing home discharge. The comprehensive FIM score was a stronger predictor of outcome than motor impairment in isolation. An admission FIM of 60 or greater was associated with a higher probabili ty of functional improvement during rehabilitation. Small-vessel strok es had the best outcome. Intracerebral hemorrhages improved more than ischemic strokes but more slowly. Right hemisphere lesions did worse t han left. Comorbidities influenced outcome only when several condition s accumulated. The absence of a committed caregiver at home increased the risk of nursing home discharge. Suggestions for rehabilitation tri age are given.