How Do Recurrent and First-Ever Strokes Differ in Rehabilitation Outcomes?

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Abstract

Objective

To describe clinical characteristics and functional outcomes in recurrent stroke, identify factors associated with improved outcomes, and to compare these outcomes with first-ever stroke patients.

Design

Five-year prospective cohort study of 1277 consecutive stroke patients admitted to inpatient rehabilitation, with 16.6% recurrent stroke. Primary functional outcome measure was the Functional Independence Measure. FIM gain quantified the difference between admission and discharge FIM scores. FIM effectiveness measured the percentage recovery.

Results

In recurrent stroke patients, mean AdmissionFIM and DischargeFIM scores were 62.5 and 74.2, respectively, with a mean FIM gain of 11.7 and FIM effectiveness of 20.4%. Comparing to first-ever stroke, recurrent stroke patients were older, had higher unemployment rates, higher proportion of ischemic stroke types, and higher prevalence of hypertension, diabetes, ischemic heart disease, and depression. In multivariate analysis of the entire cohort, recurrent stroke predicted lower FIM gains and effectiveness. When the recurrent stroke group was further sub-analyzed, better FIM gain was associated with higher cognitive AdmissionFIM scores and presence of a caregiver, whereas better FIM effectiveness was correlated with higher motor AdmissionFIM scores.

Conclusions

Recurrent stroke patients made less functional gains compared to first-ever stroke patients. However, improvements were still significant and these patients should be offered comprehensive inpatient rehabilitation to optimize outcomes.

To Claim CME Credits:

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives:

Upon completion of this article, the learner will be able to: (1) Describe unique demographics, and characteristics of recurrent stroke patients admitted for inpatient rehabilitation; (2) Differentiate functional outcomes between first-ever and recurrent stroke patients; and (3) Utilize factors associated with functional improvements in recurrent strokes in treatment planning.

Level:

Advanced

Accreditation:

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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