Abstract P54: Predicting Functional Outcome of Stroke Inpatient Rehabilitation

Abstract

Stroke is a major cause of disability in western societies. Besides insight in the effectiveness of stroke inpatient rehabilitation, there is a need for studies evaluating the efficiency of rehabilitation after stroke. We aimed to study the effectiveness of inpatient stroke rehabilitation and evaluated the relative importance of demographic and clinical characteristics to predict (un)successful functional outcome of stroke inpatient rehabilitation. A total of 293 stroke patients were enrolled in this study. We assessed functional ability and quality of life (QoL) before and after inpatient stroke rehabilitation. Functional ability was assessed using the Barthel Index (BI) and the Academic Medical Center Linear Disability Score (ALDS). QoL was measured using the COOPWONCA and the Nottingham Health Profile (NHP). We used multivariable linear regression analysis to develop a model predicting functional outcome as assessed by the ALDS at discharge. We used ROC curve analysis to study the discriminatory power of the regression model for a (un)successful functional outcome. A successful outcome was defined as an ALDS discharge score of 1 or higher, i.e. able to perform difficult functional activities. An unsuccessful outcome was defined as an ALDS discharge score of -1 or lower, i.e. only able to perform simple functional activities. Results show significant improvements on both the functional ability measures (both BI score and ALDS score improved with 52% (p<.001)) and the quality of life measures (COOPWONCA improved with 9-31% (p<.05) and NHP improved with 25-56% (p<.001)). A better ALDS admission score, younger age, less severe stroke, a better BI admission score, less pain and less negative emotional reactions as measured with the NHP on admission turned out as independent predictors of a better ALDS discharge score, explaining 39.2% of its variance. ROC curve analysis showed a discriminatory power of the regression model for a successful or unsuccessful functional outcome of 80% and 93%, respectively. These prognostic factors need to be taken into account to optimize efficiency of stroke inpatient rehabilitation, like focusing on pain and negative emotional reactions, and can provide realistic therapeutic goals for stroke patients.