Functional independence: A comparison of the changes during neurorehabilitation between patients with non-traumatic subarachnoid hemorrhage and intracerebral hemorrhage or acute ischemic stroke

Publication date: Available online 16 December 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Henriette Holm Stabel, Asger Roer Pedersen, Søren Paaske Johnsen, Jørgen Feldbæk Nielsen
ObjectiveTo compare the changes in functional independence measured by the Functional Independence Measure (FIM) after specialized neurorehabilitation between patients with non-traumatic subarachnoid hemorrhage (SAH) and intracerebral hemorrhage or acute ischemic stroke (ICH/AIS).DesignHistorical cohort study comparing changes in functional independence between patients with SAH and ICH/AIS, using FIM scores from a local database, and clinical information from the Danish National Patient Registry.SettingPost-acute specialized in-patient neurorehabilitation.Participants212 first-time SAH and 448 first-time age-matched ICH/AIS patientsMain outcome measuresCrude and adjusted comparisons of FIM (total and item-by-item) measured at baseline and at discharge.ResultsPatients with SAH were admitted with a lower functional level compared to patients with ICH/AIS (FIM median 25 (IQR 18-81) versus (vs.) 78.5 (IQR 47-107)), and discharged with a lower functional level (FIM median 98 (IQR 40-116) vs. 110 (IQR 82.5-119)), although they made more progress during neurorehabilitation (FIM median change 27 (IQR 4-60) vs. 17 (7-35)). Statistically, patients with SAH had significantly better odds for obtaining functional independency in six of the 18 FIM items compared to patients with ICH/AIS: Eating (OR 3.2; 95%CI 1.7-5.8), dressing upper-body (OR 2.0; 95%CI 1.1-3.5), transfer tub/shower (OR 2.0; 95%CI 1.1-3.6), stair walking (OR 2.2; 95%CI 1.3-3.7), comprehension (OR 2.3; 95%CI 1.3-3.9), and expression (OR 3.6; 95%CI 2.0-6.5).ConclusionPatients with SAH made significantly more progress during neurorehabilitation, although they were discharged with a lower level of functional independency compared to patients with ICH/AIS. However, both patients with SAH and ICH/AIS improved their functional outcome significantly. Also, it was demonstrated that patients with SAH admitted with severe functional outcome were capable of recovering to a moderate level in functional independency.



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