Predicting Participation Level Six Month Following Inpatient Stroke Rehabilitation

Abstract

Objective(s): To explore how well discharge Functional Independence Measures motor (FIM-M) and cognitive (FIM-C) and Activity MeasureePost Acute Care Basic Mobility (AMPAC-BM), Daily Activities (AMPAC-DA) and Applied Cognition (AMPAC-AC) sub-scores predict outcome 6 months following inpatient stroke rehabilitation (ISR). Design: Retrospective analyses of clinical database. Setting: Rehabilitation unit within an academic medical center. Participants: Sixty-two of 165 (38%) ISR patients with follow-up (no differences based on follow-up) having a mean ageZ68.1(14.3) y, NIHSSZ8.1(6.4) and rehabilitation length of stayZ15.8(7.9) d. Seventy four percent had an ischemic stroke and it was a recurrent stroke ion 23%. Interventions: ISR. Main Outcome Measure(s): Stroke Impact Scale-Participation (SIS-P) and recovery scale (SIS-RS) scores 6m post-discharge, controlling for age and NIHSS. Results: Mean discharge AMPAC-BM, AMPAC-DA and AMPAC-AC subscores were 51.9(12.2), 44.6(9.0) and 41.4(10.3), respectively. Mean FIM-M and FIM-C subscores were 55.8(16.0) and 28.7(6.4) and mean SIS-P and SIS-RS scores were 56.0(25.1) and 62.9(24.9), respectively. Spearman’s rho between FIM subscores and 6m SIS scores ranged from 0.327 to 0.565 (all p<.01). Correlation coefficients for AMPAC-BM and AMPAC-DA subscores ranged from 0.435 to 0.606 (all p<.001) while coefficients between AMPAC-AC and SIS-P and SIS-RS were 0.239 (pZ.06) and 0.301 (p<.02), respectively. Separate ordinal regressions were performed for FIM and AMPAC predicting 6m SIS-P. Both were significant (p<.001) with a Nagelkerke pseudo R of 0.33 and 0.34, respectively. Similarly, regressions for FIM and AMPAC predicting 6m SIS-RS were significant (p<.001), both R Z 0.36. Conclusions: FIM and AMPAC subscales assessed at discharge from ISR hold weak to moderate univariate correlations with participation 6m after ISR. Even though much faster and easier to administer, the AMPAC appears identical with the FIM in its ability to predict participation levels 6m outcomes after ISR.