July 2018 CME Activity No. 7: Acute-Phase Predictors of 6-Month Functional Outcome in Italian Stroke Patients Eligible for In-Hospital Rehabilitation

ADDITIONAL INFORMATION

Objective: to assess early post-stroke prognostic factors in patients admitted for post-acute phase rehabilitation

Design: 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.

Learning Objectives:

After completing this activity, the learner will be able to:

Incorporate prognostic factors of good clinical outcomes after stroke in developing treatment plans for patients admitted to rehabilitation.
Identify acute phase indicators associated with favorable 6-months outcome after stroke.
Recognize the cut-off for early mobilization linked to better outcome in stroke survivors admitted to rehabilitation.

Summary