Functional independence
Abstract
Objective:
To 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).
Design:
Historical 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.
Setting: Post-acute specialized in-patient neurorehabilitation.
Participants:212 first-time SAH and 448 first-time age-matched ICH/AIS patients.
Main outcome measures:
Crude and adjusted comparisons of FIM (total and item-by-item) measured at baseline and at discharge.
Results:
Patients 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).
Conclusion:
Patients 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.