A common scenario vascular neurologists encounter are patients who ask us questions that run the gamut of: What’s going to happen after I leave the hospital or after I leave rehabilitation? The world of stroke has recently been focused on acute interventions at presentation and predictors of outcome acutely, but long-term, what are some of the things we can advise our patients? Here, the authors performed a cross-section study evaluating the association of stroke rehabilitation, as measured by improvement in functional independence motor (FIM) score on admission and discharge, with long-term mortality, as well as predictors of successful stroke rehabilitation.
1010 consecutive patients admitted for stroke rehabilitation with an FIM score < 80 and a recent (< 90 day from onset) ischemic or hemorrhagic stroke were enrolled in the study. Variables identified as independent positive correlates of FIM gain were younger age, being married, lower NIHSS score at time of rehabilitation admission, decreased time from stroke onset to rehabilitation admission, and presence of aphasia. Over a median follow up of 6.17 years, 36.9% of the subjects died. Age, coronary heart disease, atrial fibrillation, total cholesterol, and FIM gain were found to be independently associated with mortality. After adjusting for mortality risk markers, FIM gain remained a predictor of long-term mortality risk.
These study yielded some interesting results. The finding that FIM gain is a predictor of long-term mortality suggests that better functional improvement with rehabilitation decreases long-term mortality risk in stroke survivors. Of course, as the authors also point out, this association may also be confounded by the finding that younger age and lower NIHSS were associated with higher FIM gain; therefore, mortality may be a reflection of severity of stroke in an older population rather than rehabilitation, but this may still be helpful in how we counsel our patients as we transition them to rehabilitation. In addition, the finding that a higher FIM gain is associated with less time between stroke onset to rehabilitation is highly relevant and, again, not only helps us when counseling patients and their families, but may also aid in decision making at discharge.