Abstract 3310: Functional Outcome in Stroke Patients Enrolled in Early Supported Discharge Program Not Reaching Minimal Clinically Important Change in Functional Independence Measure

Abstract

Objectives: Stroke patients discharged home under early supported discharge (ESD) program generally have milder disability compared to patients discharged to in-patient rehabilitation facilities, and may not attain traditionally defined thresholds in minimal clinically important difference (MCID) as measured by Functional Independence Measure (FIM) after therapy. We aim to investigate the functional outcome in patients not attaining MCID compared to those who attained MCID in our ESD program. Methods: Consecutive patients admitted with acute stroke and discharged to ESD program of our unit during July 2007 to July 2010 were recruited. Patients were assessed at the initial and final home therapy sessions using FIM, Frenchay Activity Index (FAI), Motoricity Index (MI) and Modified Rankin Scale (MRS). MCID is defined as any increase ≥22 in FIM total score, ≥17 in FIM motor subscore, or ≥3 in FIM cognitive subscore. The proportion of patients with MRS 0-1 at the initial and final ESD sessions were determined separately in patients who attained and in those who did not attain MCID. Findings: 255 patients (60% male, mean age 65.2, SD11.7 years) were recruited, with home therapy duration from 2-6 weeks. Significant improvements (p<0.001) were found in all the functional outcome measures, with a mean improvement of 16 points (99 to 115) in FIM, 9.2 points (1.2 to 10.4) in FAI, 12 points in upper limb MI (76 to 88), and 14 points in lower limb MI (74 to 88). 126 (49.4%) patients attained MCID after ESD (23.5% in FIM total , 37.6% in FIM motor and 28.2% in FIM cognitive ). Patients who attained MCID had significantly lower mean baseline FIM scores compared to those who did not (90 SD19 vs 106 SD16, p<0.001). Significant increases in the proportion of patients with MRS 0-1 were observed both in patients who attained MCID (3.2% to 38.9%) and in those who did not (6.2% to 53.5%) after completion of ESD. Conclusions: The utility of the FIM instrument in monitoring functional outcome in stroke patients is limited by the ceiling effect. Patients with milder disability without significant changes in FIM can nevertheless achieve important functional improvements after home therapy offered by an ESD program.