Abstract WMP42: Trajectory Of Global Disability During First 90 Days Poststroke: Foundational Data For Early Rehabilitation Intervention Trials

Abstract

Background: Novel recovery interventions may be particularly beneficial started 3-10d poststroke, when patients become eligible for intensive inpatient rehabilitation and biologic neuroplasticity is at its peak. To design recovery clinical trials in this population, it is important to characterize the evolution of global disability through 3mo of conventional care. Methods: Among all ischemic stroke (IS) and intracranial hemorrhage (ICH) patients enrolled in an NIH multicenter acute treatment trial (FAST-MAG), we analyzed disability course among patients discharged to acute inpatient rehabilitation facilities (IRFs) 2-9 days poststroke. Results: Among 1426 IS and ICH patients, 255 (17.9%) were discharged to IRFs, including 12.8% within 2-9d and 5.1% beyond 9d. Among IS patients, rate of 2-9d discharge to IRFs was 13.0% (135/1041), age 71.1 (±12.4), 42% female, NIHSS on first hospital arrival 10.3 (±6.8), and global disability on day 4 mRS=3 in 15.9% and mRS=4 in 43.8%. Among ICH patients, rate of 2-9d discharge to IRFs was 12.2% (47/385), age 62.4 (±11.7), 32.9% female, NIHSS on first hospital arrival 11.5 (±5.7), and global disability on day 4 mRS=3 in 12.2% and mRS=4 in 45.1%. Among Day 4 mRS 3-4 patients, mRS improvement by 90d among ICH and IS patients was 83.0% vs 72.6%, p = 0.17. Mean mRS change for ICH and IS was -1.5 (±1.1) vs -1.3 (±1.4) (Figure). Final 90D mRS among ICH and IS patients was mean 2.2 (±1.1) vs 2.4 (±1.5). Conclusion: In this broad acute stroke patient cohort, 1 in 8 patients were transferred to inpatient rehabilitation within 2-9d days poststroke. Intracranial hemorrhage patients had nominally greater improvement on the mRS by 90d than ischemic stroke patients. This course delineation provides a roadmap for future rehabilitation intervention studies.