Acute-phase predictors of 6-month functional outcome in Italian stroke patients eligible for In-Hospital Rehabilitation

AbstractPurposeto assess early post-stroke prognostic factors in patients admitted for post-acute phase rehabilitation.Methodsa one-year multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for post-acute rehabilitation. Clinical data were collected in the Stroke or Acute Care Units (acute phase), then in Rehabilitation Units (post-acute phase) and, subsequently, after a 6-month post-stroke period (follow-up). Clinical outcome measures were represented using the Barthel Index (BI) and the modified Rankin Scale (mRS). Univariate and multivariate analyses were performed to identify the most important prognostic index.ResultsmRS score, minor neurologic impairment and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to BI (power of prediction = 37%). Similarly, age, pre-morbid mRS score and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the mRS (power of prediction = 48%). BI at admission and certain comorbidities were also significant prognostic factors correlated with a better outcome.Conclusionsaccording to the BI and mRS, early mobilization is an early predictor of favorable outcome. Purpose to assess early post-stroke prognostic factors in patients admitted for post-acute phase rehabilitation. Methods a one-year multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for post-acute rehabilitation. Clinical data were collected in the Stroke or Acute Care Units (acute phase), then in Rehabilitation Units (post-acute phase) and, subsequently, after a 6-month post-stroke period (follow-up). Clinical outcome measures were represented using the Barthel Index (BI) and the modified Rankin Scale (mRS). Univariate and multivariate analyses were performed to identify the most important prognostic index. Results mRS score, minor neurologic impairment and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to BI (power of prediction = 37%). Similarly, age, pre-morbid mRS score and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the mRS (power of prediction = 48%). BI at admission and certain comorbidities were also significant prognostic factors correlated with a better outcome. Conclusions according to the BI and mRS, early mobilization is an early predictor of favorable outcome. Corresponding author: Marco Franceschini, Department of Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy, Via della Pisana 235, 00163, Rome - Italy. Tel + 39 06 52252402 - fax +39 06 52255683. e-mail: marco.franceschini@sanraffaele.it Sources of Funding The project received financial support from Italian Ministry of Health for the Implementation of Stroke Care (ISC Study) within the CCM 2010 program. Subject Terms: Prognosis, Rehabilitation, Cerebrovascular Disease/Stroke Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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