Predictive model of functional independence in stroke patients admitted to a rehabilitation programme

Abstract

Objective: To develop a prognostic model to estimate the probability of patients being independent in ambulation and in activities of daily living (ADL) after six months of stroke. Design: Cohort analytical study. Setting: Rehabilitation departments of two district general hospitals. Subjects: Ninety-two consecutive stroke patients admitted to a rehabilitation programme. Main outcome measures: Independent ambulation was defined as a Functional Ambulation Classification (FAC) ≥4, and the independence in ADL as a Barthel Index (BI) ≥85. All patients were assessed on admission to rehabilitation, and in the first, second, third, fourth and six months after stroke. Results: Prognostic factors were identified by means of a multivariate survival analysis using Cox regression. Three variables were predictors for a FAC ≥4: (1) The patients in the motor (M), motor-sensitive (MS) and motor-sensitive with hemianopsia (MSH) groups (relative risk (RR) 5.43 of M with respect to MSH, and 2.41 of MS to MSH). (2) A Motricity Index >25 (RR 3.19). (3) An age <70 years old (RR 1.99). For a BI ≥85 three predictors were selected: (1) The classification M–MS–MSH (RR 6.02 M to MSH, and 1.52 MS to MSH). (2) An initial BI >20 (RR 3.45); the highest contribution in the achievement of an initial BI >20 was bowel and bladder continence. (3) The antecedent of previous independence (RR 2.68). The predictive models, constructed by means of multiple logistic regression correctly classified 77% and 79% of the patients who obtained FAC ≥4 and a BI ≥85 respectively. Conclusions: The syndromic classification M, MS and MSH, together with other routinely available data, such as the Motricity Index, BI, the age and the previous functionality, can be used to obtain a patient prognosis level with regard to ambulation and ADL independence.