Eldelry/Long-term Care

Patients with the poorest functioning after a stroke benefit the most from followup therapy

Nearly 5 million Americans are living with the effects of a stroke. These effects range from weakness on one side of the body and inability to walk to problems with memory, learning, and awareness. Inpatient rehabilitation programs can improve motor and cognitive function after a stroke. However, these programs have been shortened because the length of a hospital stay for stroke has decreased, prompting the need for followup therapy. Stroke victims who seem to benefit most from followup therapy are those discharged from the hospital with the poorest functioning, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11618).

Researchers analyzed data from the Uniform Data System for Medical Rehabilitation (UDSMR), a large national registry of information on U.S. medical rehabilitation inpatients. They combined followup data with the UDSMR inpatient record from 1994 to 2001 for 45,164 patients who received inpatient medical rehabilitation after a stroke (mean age 69.5 years). UDSMR data includes ratings on standardized measures of basic daily living skills, the FIM™ instrument, demographics, length of hospital stay, and other information. The FIM™ instrument includes 18 items on functioning, with each rated from 1 (complete dependence) to 7 (complete independence), with total possible ratings ranging from 18 to 126.

The six function domains are self-care, sphincter control, transfers, locomotion, communication, and social cognition. The patients who made the highest gain in functioning (based on FIM™ instrument ratings) due to followup therapy were those with a low discharge FIM™ rating of 65 or less (average gain of 19.4 points between discharge and followup assessment compared with 15.1 points for persons in this range who did not receive followup therapy). In contrast, followup therapy did not affect the functioning of patients discharged with FIM™ ratings over 75, who may have had only mild or moderate functional limitations at discharge, and home and community activities alone may have been sufficient to improve their functioning. These findings may assist clinicians in discharge planning for stroke victims.

See "Examination of follow-up therapy in patients with stroke," by Yong-Fang Kuo, Ph.D., Glenn V. Ostir, Carl V. Granger, and Kenneth J. Ottenbacher, Ph.D., O.T.R., in the March 2006 American Journal of Physical Medicine and Rehabilitation 85(3), pp. 192-200.

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