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October 2016 CME Article No. 10: How Do Recurrent and First-Ever Strokes Differ in Rehabilitation Outcomes?
Additional Information
Objective:
To describe clinical characteristics and functional outcomes in recurrent stroke, identify factors associated with improved outcomes, and to compare these outcomes with first-ever stroke patients.

Design:
Five-year prospective cohort study of 1277 consecutive stroke patients admitted to inpatient rehabilitation, with 16.6% recurrent stroke. Primary functional outcome measure was the Functional Independence Measure. FIM gain quantified the difference between admission and discharge FIM scores. FIM effectiveness measured the percentage recovery.

Results:
In recurrent stroke patients, mean AdmissionFIM and Discharge FIM scores were 62.5 and 74.2, respectively, with a mean FIM gain of 11.7 and FIM effectiveness of 20.4%. Comparing to first-ever stroke, recurrent stroke patients were older, had higher unemployment rates, higher proportion of ischemic stroke types, and higher prevalence of hypertension, diabetes, ischemic heart disease, and depression. In multivariate analysis of the entire cohort, recurrent stroke predicted lower FIM gains and effectiveness. When the recurrent stroke group was further sub-analyzed, better FIM gain was associated with higher cognitive Admission FIM scores and presence of a caregiver, whereas better FIM effectiveness was correlated with higher motor Admission FIM scores.

Conclusions:
Recurrent stroke patients made less functional gains compared to first-ever stroke patients. However, improvements were still significant and these patients should be offered comprehensive inpatient rehabilitation to optimize outcomes.

Learning Objectives:
  1. Describe unique demographics, and characteristics of recurrent stroke patients admitted for inpatient rehabilitation
  2. Differentiate functional outcomes between first-ever and recurrent stroke patients
  3. Utilize factors associated with functional improvements in recurrent strokes in treatment planning
Summary
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