Henriette Holm Stabel1, Asger Roer Pedersen2, Søren Paaske Johnsen3, Jørgen Feldbæk Nielsen2. 1. Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark. Electronic address: henriette.holm.stabel@midt.rm.dk. 2. Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark. 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
OBJECTIVE: To compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). DESIGN: Historical cohort study comparing changes in functional independence between patients with nontraumatic SAH and those with ICH/AIS, using FIM scores from a local database and clinical information from the Danish National Patient Registry. SETTING: Postacute specialized inpatient neurorehabilitation. PARTICIPANTS: Participants (N=660) comprised patients with a first-time nontraumatic SAH (n=212) and age-matched patients with a first-time ICH/AIS (n=448). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Crude and adjusted comparisons of FIM (total and item by item) measured at baseline and at discharge. RESULTS: Patients with nontraumatic SAH were admitted with a lower functional level compared with patients with ICH/AIS (median total FIM score, 25 [interquartile range (IQR), 18-81] vs 78.5 [IQR, 47-107]), and discharged with a lower functional level (median total FIM score, 98 [IQR, 40-116] vs 110 [IQR, 82.5-119]), although they made more progress during neurorehabilitation (median change in total FIM score, 27 [IQR, 4-60] vs 17 [IQR, 7-35]). Statistically, patients with nontraumatic SAH had significantly better odds for obtaining functional independence than did patients with ICH/AIS in 6 of the 18 FIM items: eating (odds ratio [OR]=3.2; 95% confidence interval [CI], 1.7-5.8); dressing-upper body (OR=2.0; 95% CI, 1.1-3.5); transfer tub/shower (OR=2.0; 95% CI, 1.1-3.6); stair walking (OR=2.2; 95% CI, 1.3-3.7); comprehension (OR=2.3; 95% CI, 1.3-3.9); and expression (OR=3.6; 95% CI, 2.0-6.5). CONCLUSIONS: Patients with nontraumatic SAH made significantly more progress during neurorehabilitation, although they were discharged with a lower level of functional independence compared with patients with ICH/AIS. However, both patients with nontraumatic SAH and those with ICH/AIS improved their functional outcome significantly. Also, patients with nontraumatic SAH admitted with severe functional outcome were shown to be capable of recovering to a moderate level of functional independence.
OBJECTIVE: To compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). DESIGN: Historical cohort study comparing changes in functional independence between patients with nontraumatic SAH and those with ICH/AIS, using FIM scores from a local database and clinical information from the Danish National Patient Registry. SETTING: Postacute specialized inpatient neurorehabilitation. PARTICIPANTS: Participants (N=660) comprised patients with a first-time nontraumatic SAH (n=212) and age-matched patients with a first-time ICH/AIS (n=448). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Crude and adjusted comparisons of FIM (total and item by item) measured at baseline and at discharge. RESULTS:Patients with nontraumatic SAH were admitted with a lower functional level compared with patients with ICH/AIS (median total FIM score, 25 [interquartile range (IQR), 18-81] vs 78.5 [IQR, 47-107]), and discharged with a lower functional level (median total FIM score, 98 [IQR, 40-116] vs 110 [IQR, 82.5-119]), although they made more progress during neurorehabilitation (median change in total FIM score, 27 [IQR, 4-60] vs 17 [IQR, 7-35]). Statistically, patients with nontraumatic SAH had significantly better odds for obtaining functional independence than did patients with ICH/AIS in 6 of the 18 FIM items: eating (odds ratio [OR]=3.2; 95% confidence interval [CI], 1.7-5.8); dressing-upper body (OR=2.0; 95% CI, 1.1-3.5); transfer tub/shower (OR=2.0; 95% CI, 1.1-3.6); stair walking (OR=2.2; 95% CI, 1.3-3.7); comprehension (OR=2.3; 95% CI, 1.3-3.9); and expression (OR=3.6; 95% CI, 2.0-6.5). CONCLUSIONS:Patients with nontraumatic SAH made significantly more progress during neurorehabilitation, although they were discharged with a lower level of functional independence compared with patients with ICH/AIS. However, both patients with nontraumatic SAH and those with ICH/AIS improved their functional outcome significantly. Also, patients with nontraumatic SAH admitted with severe functional outcome were shown to be capable of recovering to a moderate level of functional independence.
Authors: Neus Gual; Laura Mónica Pérez; Carmina Castellano-Tejedor; Pilar Lusilla-Palacios; Judith Castro; Luís Soto-Bagaria; Laura Coll-Planas; Marta Roqué; Ana Belen Vena; Benito Fontecha; Jose M Santiago; Eva Månsson Lexell; Carlos Chiatti; Susanne Iwarsson; Marco Inzitari Journal: BMC Geriatr Date: 2020-09-04 Impact factor: 3.921
Authors: Erhard Næss-Schmidt; Nils-Bo de Vos Andersen; David Høyrup Christiansen; Jørgen Feldbæk Nielsen; Peter William Stubbs Journal: BMJ Open Date: 2020-11-03 Impact factor: 2.692