On the prognosis of outcome after stroke

Objectives - The study was aimed at improving the accuracy of prognosis for recovery of function in patients suffering a first stroke. Materials and m ethods - Two-hundred and forty-eight patients were enrolled. The mean inter val since the stroke was 23 days. Patients entered a rehabilitation program lasting 60 days. The predictive value of 12 factors were analysed, namely motor, cognitive and sphincter subitems of Functional Independence Measure at admission (FIM-a), age, sex, education, body mass index (BMI), depressio n, neglect, aphasia, ideomotor and constructive apraxia. FIM score at disch arge was the dependent variable. Results - A multiple regression revealed t hat only age, cognitive and sphincter subitems of FIM-a, neglect and ideomo tor apraxia were significantly associated with outcome. Moreover, these fac tors accounted for only 72% of the variance in outcome scores. A decision o f unfavourable prognosis on the basis of a FIM-a value lower than 40 was in correct in 2.8% of the patients in this study and in 8.2% of those having a FIM score lower than 40. Conclusions - The use of statistical methods to e xamine the outcome after stroke is useful for expressing probability on a g roup basis but is unsuitable for determining the prognosis of individual pa tients. Such data should not be used for fiscal management. A significant m inority of patients presenting with a FIM lower than 40 can regain a useful measure of independence. The errors in prognosis based upon available meth ods, although small, have unacceptable effects in human terms if they lead to the clinical decisions which deny patients rehabilitation. All of the pa tients should therefore be admitted for rehabilitation after their first st roke. Severe comorbidity requires special attention.