Influence of initial status on functional gain for Japanese patients with first cerebral hemorrhage

It is important to identify in advance patients who will achieve the greate st functional gains from rehabilitation therapy, as specialist rehabilitati on resources are still scarce in Japan. The purpose of this study was to de termine whether functional score at admission influences the functional cha nge (functional score at discharge minus functional score at admission) aft er inpatient rehabilitation for first cerebral hemorrhage. One hundred and ninety-three patients with cerebral hemorrhage were enrolled in this study. They were assessed using the Functional Independence Measure (FIM) at admi ssion and discharge and underwent inpatient rehabilitation treatment. Patie nts were stratified into 3 groups according to their FIM total scores on ad mission as follows: (1) less than or equal to 36 (severely affected patient group); (2) 37-72 (moderately affected patient group); and (3) greater tha n or equal to 73 (mildly affected patient group). Scheffe's multiple compar ison test showed that patients in group 1 were significantly older (mean+/- SD = 63 +/- 10 years) than those in groups 2 (56 +/- 10 years) or 3 (53 +/- 12 years). Patients in group 2 showed significantly greater FIM gain (37 /- 17) compared with patients in groups 3 (23 +/- 12) or 1 (27 +/- 23). The results suggest that moderately affected patients at admission will show s ignificantly higher functional gain compared with severely or mildly affect ed patients. Mildly affected patients at admission had a significantly shor ter length of hospital stay for rehabilitation than the other groups. There was no significant difference in onset to admission interval between the 3 groups. The functional levels of affected patients on admission, as strati fied by the FIM scale, roughly predict the degree of functional gain follow ing rehabilitation in patients with first cerebral hemorrhage. Moderately a ffected patients will benefit from intensive rehabilitation. This study may be useful in determining how best to prioritize rehabilitation therapy.