Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: A prospective observational study

Issue title: Perspectives on Behavior and Acquired Brain Injury

Guest editors: Harvey E. Jacobs

Article type: Research Article

Authors: Hayward, Kathryn S.^a | Kuys, Suzanne S.^{b; c} | Barker, Ruth N.^{d; e} | Brauer, Sandra G.^{f; *}

Affiliations: [a] Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia | [b] School of Rehabilitation Sciences, Griffith University, Gold Coast, Australia | [c] Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia | [d] Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia | [e] Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, Australia | [f] Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia

Correspondence: [*] Address for correspondence: Sandra G. Brauer, Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane 4072, Australia. Tel.: +61 7 3365 2275; Fax: +61 7 3365 1622; E-mail: s.brauer@uq.edu.au

Abstract: Background:A good motor outcome after stroke is often equated with independence in functional performance. However, for patients with severe motor disability a good outcome is unlikely, but an important change may be achievable. Objective:Determine if patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function. Methods:A prospective observational study of 239 patients with stroke admitted to inpatient rehabilitation in Brisbane, Australia was conducted. On admission and discharge, participants were assessed using the motor items of the Functional Independence Measure (m-FIM). The importance of change achieved on the m-FIM was evaluated according to: 1) a statistical significant outcome; 2) achievement of a MCID based on a physician-anchored rating of change; and 3) shift in disability status e.g., severe to moderate disability. Results:Patients with severe motor disability achieved a significant improvement in motor function (p < 0.001), which saw up to 83% achieve a MCID and 85% shift out of ‘severe’ to either moderate or mild motor disability on discharge from inpatient rehabilitation. Conclusion:This study demonstrates that patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function on discharge from inpatient rehabilitation.

Keywords: Stroke, inpatient rehabilitation, functional recovery, severe, motor

DOI: 10.3233/NRE-141076

Journal: NeuroRehabilitation, vol. 34, no. 4, pp. 773-779, 2014