The relation between impairments and functional outcomes poststroke

Objective: To assess the influence of initial stroke impairments on the sev erity of basic and higher level functional deficits over time and to determ ine the cumulative impact on functional deficits beyond severity of motor d eficits alone. Design: Observational study. Setting: Twelve participating hospitals in the Greater Kansas City area, as parr of the Kansas City Stroke Study (October 1995-March 1998), Participants: Individuals (n = 459) who sustained an eligible stroke were e valuated prospectively using standardized assessments at enrollment (within 14 days of stroke onset, 8.8 +/- 3.5 days). Main Outcome Measures: Mobility and activities of daily living (ADLs) were assessed at 1, 3, and 6 months poststroke using the Functional Independence Measure(TM), Barthel index, Lawton Instrumental Activities of Daily Living (IADL), and the Medical Outcomes Study Short-Form Health Survey instrument s, Results: The cumulative probability of achieving independence with walking, a Barthel index of 60 or greater or 90 or greater, and independence in 3 o r more IADL was significantly different for the following 4 impairment grou ps in descending order: motor; motor and somatosensory; motor and hemianopi a; and motor, sensory, and hemianopia. Although motor severity was a strong predictor of outcome (p < .0001), the additional somatosensory and hemiano pia deficits significantly (p < .05) affected time and likelihood of achiev ing these levels of function. Conclusion: Cumulative deficits poststroke affect patients' functional outc ome in the first 6 months poststroke beyond the effect of motor severity al one.