One-year follow-up in stroke patients discharged from rehabilitation hospital

This study was designed to evaluate functional status at a 1-year follow-up in consecutive first-stroke patients after discharge from rehabilitation h ospital and to identify reliable prognostic factors associated with changes in their abilities. Functional evaluation was made of consecutive patients 1 year after discharge to their own homes. Two multiple logistic regressio ns (forward stepwise) were performed using both improvement and worsening o f the Barthel Index score between discharge and follow-up as dependent vari ables. Independent variables were medical, demographic and social factors. The final sample included 157 out of 172 patients. During the follow-up, 10 patients (5.81%) died because of a new cerebrovascular event, 1 patient di ed of myocardial infarction, 2 patients had new strokes and 2 fractured the ir paretic legs. Functionally, 43.3% of the patients maintained the level t hey achieved during inpatient rehabilitation treatment, 23.6% improved and the remaining 33.1% worsened. Patients with hemineglect and aged greater th an or equal to 65 years had a higher probability of functional worsening (o dds ratio, OR = 3.77, 95% confidence interval, CI = 1.42-10.0 and OR = 3.93 , 95% CI = 1.72-8.95, respectively). Postdischarge rehabilitation (performe d for 46.5% of the final sample) was significantly and positively associate d with functional improvement (OR = 7.23, 95% CI = 2.89-18.05), and its abs ence with functional worsening (OR = 12.32, 95% CI = 4.47-37.01). In conclu sion, in nearly half of the cases, functional status was still not stabiliz ed at the time of discharge from the rehabilitation hospital. Postdischarge outpatient treatment was useful for preventing worsening of the functional ability achived during inpatient treatment and increased the possibility o f further functional improvement. Age greater than or equal to 65 years and hemineglect were predictors of functional worsening at follow-up. Copyrigh t (C) 2000 S. Karger AG, Basel.