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PubMed1993

Issues in contemporary cardiac rehabilitation: a historical perspective.

Cardiac rehabilitation consists of exercise, psychosocial support and education and is prescribed most often for patients with coronary heart disease. Its purpose is to facilitate readaptation to normal life through the achievement of maximal functional capability and to reduce heart disease risk factors. It began historically with progressive ambulation after myocardial infarction and by 1980 became a standardized inpatient therapy performed according to a stepped procedure. Predischarge exercise testing was added and has become a meaningful contribution to the concept of risk stratification after an acute coronary event. Rehabilitation has subsequently become part of the outpatient environment and is delivered by multiple models. Meta-analyses have shown that rehabilitation reduces overall and cardiovascular deaths by about 20% and sudden death by about 37% during the year after an acute myocardial infarction. The significance of this, however, must now be modulated by the dynamic role of aggressive coronary intervention. Selection for such intervention has become an important adjunctive aspect of rehabilitation. Newer findings suggest that those stratified at low risk will benefit most by the modification of coronary risk factors, and that patients previously thought to be poor candidates for rehabilitation (such as those with significant left ventricular dysfunction and low work capacity) may experience substantial relative functional benefit. Beyond risk stratification, important contemporary issues include surveillance of patients after angioplasty, the effectiveness of rehabilitation in the attenuation or reversal of both native and vein graft atherosclerosis and consideration of such currently emphasized end points as quality of life and economic evaluation.

Bed Rest↗
PubMed2006

[Multiresistant bacteria colonisation in rehabilitation units].

The objective of this study was to evaluate the management of multiresistant bacteria infection in French rehabilitation units. We e-mailed a questionnaire to French rehabilitation practitioners asking them what they did and what they knew about multiresistant bacteria colonisation. Their answers are described and analysed. We received 60 answers representing most of the country's rehabilitation centers. Routine screening was rare, but multiresistant bacteria were often looked for when certain risk factors were present. Methicillin-resistant Staphylococcus aureus and multiresistant enterobacteria were the usual target germs. In general, respondents asked for evidence-based recommendations that are also applicable without too great a prejudice (for the rehabilitation as well as for the psychological state) for a patient hospitalised in a rehabilitation unit. The legal risks and the costs involved are also to be tested. Many questions lay unanswered, although the literature is rich in descriptions of this area. The opposition between the medical advice of isolation and the readaptation objectives of a rehabilitation unit are strong. This study aims to highlight the most important uncertainties so as to promote prospective studies and enlighten the legal authorities.

Drug Resistance, Multiple↗
PubMed2004

Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlled trial.

OBJECTIVE: To test the hypothesis that balance rehabilitation with visual cue deprivation improves balance more effectively than rehabilitation with free vision. DESIGN: Single-blind, randomized controlled trial. SETTING: Public rehabilitation center in France. PARTICIPANTS: Twenty patients with hemiplegia after a single-hemisphere stroke that occurred at least 12 months before the study. INTERVENTION: Patients were randomly assigned to 1 of 2 balance rehabilitation programs-with and without visual cue deprivation. In all other respects, the programs were identical. Each lasted for 1 hour and was implemented 5 days a week for 4 weeks. All patients completed the program. Mean outcome measures Balance under 6 sensory conditions was assessed by computerized dynamic posturography (EquiTest), gait velocity, timed stair climbing, and self-assessment of ease of gait before and after program completion. RESULTS: After completing the program, balance, gait velocity, and self-assessment of gait improved significantly in all patients. The improvements in gait velocity (P= .03) and timed stair climbing (P= .01) correlated significantly with improved balance. Balance improved more in the vision-deprived group than in the free-vision group. CONCLUSIONS: Balance improved more after rehabilitation with visual deprivation than with free vision. Visual overuse may be a compensatory strategy for coping with initial imbalance exacerbated by traditional rehabilitation.

Cues↗
PubMed2004

The effect of poststroke cognitive impairment on rehabilitation process and functional outcome.

OBJECTIVES: To determine whether cognitive impairment affects access to, or quality of, rehabilitation services, and to examine the effects of functional outcomes in stroke patients. DESIGN: Secondary analysis of prospective cohort of stroke patients followed for 6 months after stroke. SETTINGS: Eleven large-volume US Department of Veterans Affairs hospitals nationwide. PARTICIPANTS: Stroke patients (N=272) who were candidates for rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score. Functional outcomes were performance of activities of daily living (ADLs), measured by the FonFIM, and instrumental activities of daily living (IADLs), measured by Lawton, at 6-month follow-up. RESULTS: Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients. Although most cognition-related treatment elements were similar for both groups, cognitive goals were more frequently charted in impaired patients. Controlling for baseline function and rehabilitation process, cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients; cognition did not significantly influence ADL performance. CONCLUSIONS: Quality of, and access to, rehabilitative care was equivalent for patients with and without cognitive impairment. Despite a similar rehabilitation process, cognitively impaired stroke patients experienced worse recovery of IADLs.

Activities of Daily Living↗
PubMed2005

Evidence-based practice and the limits of rational rehabilitation.

Both the American Congress of Rehabilitation Medicine and the field of physical medicine and rehabilitation have entered an age of evidence-based rehabilitation. Despite some concerns over the difficulties in applying the methods of evidence-based practice to rehabilitation research, there is little question that we will continue to move in this direction. This will also require the translation of scientific evidence into clinical practice. Rather than representing opposing approaches to practice, the integration of the best available scientific evidence with clinical experience and judgment represent 2 of the pillars of evidence-based practice. However, we also need to recognize the subjective nature of clinical decision making as a fundamental aspect of human judgments. Finally, we need to acknowledge the subjective meanings of illness and disability to the patients we serve. Any efforts to build our practice based on the best available systematic evidence are unlikely to succeed unless we include patients values and beliefs and incorporate this perspective into our rehabilitation research. This aspect of evidence-based rehabilitation raises important questions about our fundamental roles and how we will choose to practice and define our field in the future.

Attitude of Health Personnel↗
PubMed2005

Clinical characteristics and rehabilitation outcomes of patients with posterior cerebral artery stroke.

OBJECTIVES: To describe the demographics, clinical profile, and functional outcomes in posterior cerebral artery (PCA) stroke and to identify factors associated with functional change during rehabilitation and discharge disposition. DESIGN: Retrospective study of patients with PCA stroke admitted to a rehabilitation hospital over an 8-year period. SETTING: Free-standing urban rehabilitation hospital in the United States. PARTICIPANTS: Eighty-nine consecutive patients with PCA stroke (48 men, 41 women; mean age, 71.5y) met inclusion criteria. INTERVENTION: Inpatient multidisciplinary comprehensive rehabilitation program. MAIN OUTCOME MEASURES: Demographic, clinical, and discharge disposition information were collected. Functional status was measured using the FIM instrument, recorded at admission and discharge. The main outcome measures were the discharge total FIM score, the change in total FIM score (DeltaFIM), and the discharge disposition. Multiple and logistic regression analyses were performed to identify factors associated with the main outcome measures. RESULTS: The most common impairments were motor paresis (65%), followed by visual field defects (54%) and confusion or agitation (43%). The mean discharge total FIM score +/- standard deviation was 88.3+/-28.2. The mean DeltaFIM was 23.3+/-16.4. Fifty-five (62%) patients were discharged home. On multiple regression analysis, higher admission total FIM score, longer length of stay (LOS), and a rehabilitation stay free of interruptions were associated with higher discharge total FIM score and greater DeltaFIM. Absence of diabetes mellitus and younger age were also associated with higher discharge total FIM scores, and male sex had greater DeltaFIM. On logistic regression analysis, younger patients, higher discharge FIM scores, presence of a caregiver, and the nonnecessity for 24-hour support were associated with a discharge to home. CONCLUSIONS: Motor, visual, and cognitive impairments are common in PCA stroke, and good functional gains are achievable after comprehensive rehabilitation. Higher admission FIM scores, longer LOS, and younger and male patients were associated with better functional outcomes. Most patients were discharged home, particularly those with caregivers and those for whom 24-hour support was not required. Further research should aim at the development of functional outcome measures of greater breadth and sensitivity to visual and cognitive deficits and should compare PCA stroke outcomes with outcomes of strokes in other vascular territories.

Aged↗
PubMed2005

Factors affecting the uptake of cardiac rehabilitation services in a rural locality.

INTRODUCTION: A number of studies have investigated factors affecting uptake of cardiac rehabilitation services. However, little information on factors affecting uptake of services in rural localities is available. STUDY DESIGN: A cross-sectional survey. METHODS: A survey of patients eligible for cardiac rehabilitation was undertaken to investigate uptake of services. The effects of individual and geographic factors on service utilization were explored. RESULTS: Utilization rates for cardiac rehabilitation services within the South Staffordshire locality are low, with 59.3% of eligible patients invited to attend cardiac rehabilitation services following discharge from hospital, 38.6% attending and 22.5% completing the programme. Two factors were independently associated with low service utilization. Patients under the age of 65 years are 1.90 [95% confidence intervals (CI) 1.01-3.65] times more likely to complete rehabilitation than patients aged over 65 years, and women are only 0.48 (95% CI 0.22-1.03) times as likely as men to complete rehabilitation. The major reported barrier to utilization of services was access. This included problems with public transport, parking and the time and location of classes. Access and medical problems were significantly higher in older people and may have contributed to their low overall completion rate. Electoral ward deprivation, geographical access score, living in an urban or rural electoral ward, electoral ward of residence and provider were not significantly associated with service utilization. CONCLUSIONS: Overall, utilization rates were low. No geographical factors were associated with uptake of services, although the possible effect may have been mediated by the relative affluence of the locality. Two individual factors, age and sex, were most likely to influence uptake.

Age Factors↗
PubMed2003

Potential impact of the new medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation.

OBJECTIVE: To evaluate the potential impact of the new Medicare prospective payment system (PPS) on traumatic brain injury (TBI) rehabilitation. DESIGN: Retrospective cohort study of patients with TBI. Patients were assigned to their appropriate case-mix group (CMG) based on Medicare criteria. SETTING: Fourteen urban rehabilitation facilities throughout the United States. PARTICIPANTS: Patients with TBI admitted to inpatient rehabilitation and enrolled in the Traumatic Brain Injury Model Systems from 1998 to 2001 (N=1807). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes. RESULTS: The median cost of inpatient rehabilitation for patients with TBI exceeded median PPS payments for all TBI CMGs by 16%. Only 3 of the 14 hospitals received reimbursement under PPS that exceeded costs for their TBI patients. CONCLUSIONS: Compared with current costs, the new Medicare payment system may reimburse facilities significantly less than their costs for the treatment of TBI. To maintain their current financial status, facilities may have to reduce LOS and/or reduce resource use. With a decreased LOS, inpatient rehabilitation services will have to improve FIM efficiency or discharge patients with lower discharge FIM scores.

Adult↗
PubMed2003

Cultural competence in the multidisciplinary rehabilitation setting: are we falling short of meeting needs?

We present issues relevant to rehabilitation providers who wish to develop or improve their cultural competence in their medical setting and interdisciplinary team. Two case scenarios are presented that illustrate the complexities introduced into the medical rehabilitation setting by the increased numbers of minority patients in the United States in the last 20 years. Professional codes of conduct and practice are discussed for 3 rehabilitation disciplines: physiatry, rehabilitation psychology and neuropsychology, and nursing. The current status of and improvements in professional and continuing medical education are then outlined. Challenges faced by rehabilitation providers seeking to become more culturally competent in their practices are related in the following topic areas: (1) continuing education in language and cultural issues, (2) assessment instruments appropriate for diverse patient populations, (3) majority versus minority population values and beliefs, (4) impact of the immigration and acculturation experiences, (5) health care and insurance coverage issues, (6) attitudes and beliefs about disability, and (7) past experiences with medical professionals and systems. Suggestions for developing and applying enhanced cultural awareness in clinical rehabilitation practice are provided.

Adult↗
PubMed1996

Physical, psychological, and social outcomes in geriatric rehabilitation patients.

OBJECTIVE: Previous research studies that addressed the relationship between age and functional outcome had limited generalizability because of small sample size, lack of an urban population, and limited variables that do not allow for a complete investigation of social, cognitive, psychological, and medical factors in geriatric rehabilitation. The present study attempted to assess the relationship between decade of geriatric life (60s, 70s, 80s, and 90+) and functional outcome. DESIGN: Survey study of geriatric cohorts. SETTING: Inpatient university-affiliated rehabilitation hospital. PATIENTS: 812 urban geriatric rehabilitation patients divided into four groups based on decade of life. MAIN OUTCOME MEASURES: Index of comorbid disease, principal diagnoses, Functional Independence Measure, Mattis Dementia Rating Scale, Geriatric Depression Scale, CAGE alcohol questionnaire, and residential status at admittance and discharge. RESULTS: Although there were no significant demographic differences between groups (apart from age), there were differences in functional outcome suggesting that the younger old (60s and 70s) and the older old (80s and 90+) patients may represent two different rehabilitation groups. CONCLUSIONS: The younger old patients showed significantly higher alcohol abuse and comorbid physical disease, while the older-old patients demonstrated significantly poorer cognitive skills and more dependent social status on discharge from the rehabilitation facility. Despite the younger group's physical problems and alcohol use, they demonstrated better physical recovery. Implications for working with these two groups of urban geriatric patients in a rehabilitation setting are discussed.

Activities of Daily Living↗
PubMed1997

Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury.

OBJECTIVE: The increasing use of disability measures requires that the validity of these instruments be adequately demonstrated. This study sought to evaluate the concurrent validity of one disability measure, the Functional Independence Measure (FIMSM) using minutes of care reported by nursing staff. STUDY DESIGN: Correlational, cohort design. SETTING: Eight inpatient medical rehabilitation hospitals that subscribe to the Uniform Data System for Medical Rehabilitation. PATIENTS OR OTHER PARTICIPANTS: 129 patients with traumatic brain injury (TBI) and 53 patients with traumatic spinal cord injury (SCI). INTERVENTIONS: Routine rehabilitation care. MAIN OUTCOME MEASURES: Patient-nurse contact times were recorded with a stop watch for a 24-hour period during the first and last weeks of inpatient rehabilitation. The FIM was also completed during the first and last weeks of rehabilitation. RESULTS: Contact times declined from the first to last weeks of rehabilitation, concurrent with improving scores on motor and cognitive measures derived from the FIM. Statistically significant correlations between contact times and FIM measures were observed for medication dispensing, treatment provision, and teaching/activities of daily living at admission and discharge. Smaller and usually nonsignificant correlations were observed in activities that did not involve direct patient contact. Contact times increased exponentially as disability increased. CONCLUSIONS: These results support the construct validity of the FIM by demonstrating strong relationships (r values in the range of .40 to .60) between burden of care and a measure of disability.

Adult↗
PubMed1997

Functional measures of first-stroke rehabilitation inpatients: usefulness of the Functional Independence Measure total score with a clinical rationale.

OBJECTIVE: The Functional Independence Measure (FIM) was used to measure function in first-stroke patients on admission to and discharge from a rehabilitation center, and to determine gain; all data were analyzed by a clinically oriented approach. DESIGN: All patients admitted after a first supratentorial stroke to a comprehensive rehabilitation facility over a 2-year period were examined prospectively with the FIM. Diagnosis was determined by neuroimaging. Data were collected continuously and stored in the departmental database. For analysis of data, the patients were divided by side of lesion (right or left hemisphere), main clinical syndrome (presence or absence of neglect or aphasic syndromes in those with damage to the right or left hemisphere, respectively), type of lesion (ischemic, hemorrhagic, etc), and site of lesion (cortical or subcortical). SETTING: Neurological rehabilitation ward. PATIENTS: The study population included 151 patients of average age 60.8 years; 60% were men. All were admitted an average of 28.9 days after stroke and rehabilitated for 109.3 days. MAIN OUTCOME MEASURE: The raw FIM total score was determined at 48 to 72 hours after admission and at discharge. FIM gain was calculated by subtracting the FIM discharge score from the FIM admission score for each individual. Length of stay was also recorded. RESULTS: There was no difference in average total FIM scores when patients were divided by side of damage (right or left hemisphere). Significant findings were obtained for the various parameters when the clinical criterion was applied. Patients with neglect or aphasia syndromes showed significantly higher gains despite their lower FIM admission scores, but they had a much longer in-hospital stay. CONCLUSION: The raw FIM total score is a simple, practical, and efficient measure of function in first-stroke patients on admission for rehabilitation, provided an appropriate clinical approach is used during data analysis. Results can be used for comparison with similar measures, determination of admission and discharge policy, and program evaluation. The presence of neglect and aphasic syndromes has a significant effect on the various measures. Length of stay in rehabilitation is also of paramount importance in stroke patients with special clinical syndromes.

Cerebrovascular Disorders↗
PubMed1998

American Congress of Rehabilitation Medicine 75th anniversary.

Despite an explosive growth of rehabilitation programs for the disabled in the years following World War II, a national professional organization that could provide a forum for exchange of scientific information on an interdisciplinary basis about multiple disability concerns did not develop. Specialization of research, education, and practice in rehabilitation has increased markedly among basic scientists, engineers, nurses, occupational therapists, orthotists and prosthetists, physical therapists, physicians, psychologists, social workers, speech pathologists, and vocational counselors. This specialization... has caused many rehabilitation-related personnel to seek a central focus of professional interaction through interdisciplinary communication. The American Congress of Rehabilitation Medicine has undergone reorganization to invite multidisciplinary membership and participation in programs advancing the arts, sciences, and practices of rehabilitation medicine. This report reviews the methodology by which the reorganization was accomplished and records the progress made in restructuring membership, program, publications, and governance. The membership body is now multidisciplinary with full participation in the scientific forum on an interdisciplinary basis by those who are active in and contributing to the advance of medical rehabilitation services for the disabled.

Physical Therapy Modalities↗
PubMed1999

Neoplastic versus traumatic spinal cord injury: an outcome comparison after inpatient rehabilitation.

OBJECTIVE: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. DESIGN: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. SETTING: Tertiary university medical centers. PATIENTS: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. MAIN OUTCOME MEASURES: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. RESULTS: Patients with neoplastic SCC had a significantly (p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. CONCLUSIONS: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.

Activities of Daily Living↗
PubMed1999

Decreasing length of stay after total joint arthroplasty: effect on referrals to rehabilitation units.

OBJECTIVE: To determine how protocols designed to decrease length of stay on orthopedic services after total joint replacements affect referrals for admission to rehabilitation units. To determine if the physical status scale of the American Society of Anesthesiologists (ASA) is a useful indicator of comorbid illnesses that affect the need for rehabilitation services. DESIGN: Cohort study; consecutive sample. SETTING: University medical center. PARTICIPANTS: All patients admitted for total joint arthroplasty between April 12 and October 14, 1997. MAIN OUTCOME MEASURE: Discharge to home or to rehabilitation unit. RESULTS: Length of stay was reduced from 6.4 days in 1995 to 5.1 days in 1997. The percentage of patients admitted to rehabilitation units increased from 18% in 1995 to 33% in 1997. Patients who are older, live alone, and have ASA scores of 3 or 4 were most likely to require admission to a rehabilitation unit. CONCLUSION: The ASA is a useful measure of comorbidity affecting the need for rehabilitation service. Efforts to decrease cost of acute care services may shift costs of care to postacute services.

Aged↗
PubMed1987

Vocational rehabilitation with the industrially injured worker.

The field of vocational rehabilitation has broadened beyond the traditional federal-state model into the private sector primarily through funding by the insurance industry via workers' compensation coverage. Most disabilities encountered by private vocational rehabilitationists are musculoskeletal injuries resulting from traumatic industrial accidents rather than congenital disabilities most often seen by the state's Department of Vocational Rehabilitation. In many cases reduction in physical tolerances, extremity use, and/or chronic pain results in the industrially injured worker not being released by the attending physician for return to work in the previous occupation. To be effective, private vocational rehabilitationists working with the industrially injured worker must have a working knowledge of residual tolerances associated with various disabilities, as well as knowledge of legal parameters of the vocational workers' compensation law for each state worked in. In addition, the ability to communicate effectively with attending physicians, attorneys, claims examiners, occupational and physical therapists, and rehabilitation nurses is concomitant with successful positive movement in the vocational rehabilitation process. As with federal and state vocational rehabilitation counselors, the ability to assess transferability of past work skills and current aptitudes is paramount in determining transferability of work skills to alternate occupations. Finally, growing networking between rehabilitation nurses, therapists, physicians, and vocational rehabilitationists is needed to improve the injured worker's ability to maximize his or her physical tolerances in viewing return to work in a position as close as possible to that performed at the time of injury.

Accidents, Occupational↗
PubMed1998

Pressure ulcer prevalence and incidence and a modification of the Braden Scale for a rehabilitation unit.

PURPOSE: We examined pressure ulcer incidence and prevalence, the cutoff score for risk for skin breakdown, and the contribution of each of the subscale risk factors of the Braden pressure ulcer risk-assessment tool in an inpatient rehabilitation unit. SUBJECTS AND SETTING: One hundred seventy adult men hospitalized on a rehabilitation unit during 1 calendar year were included in the research. Subject ages ranged from 35 to 99 years (M = 69). INSTRUMENTS: Pressure ulcer risk was assessed using the Braden Scale. METHODS: A retrospective chart review of a continuous series of 170 adult male patients hospitalized during a 1-year period on a 50-bed rehabilitation unit was conducted. Data were documented on a standardized researcher-designed form. RESULTS: A total of 46 pressure ulcers occurred, with the sacrum the most common location (46%), followed closely by the heel-ankle area (44%, n = 20). Most pressure ulcers (57%) were stage II, 24% were stage I, 15% stage III, and 4% stage IV. When using a cutoff score of 16, the Braden Scale demonstrated limited usefulness in predicting pressure ulcer development on our inpatient rehabilitation unit. Further calculations were completed, and a cutoff score of 18 or higher was found to provide better predictive value. With use of multiple logistic regression analysis, three of the six risk factors from the Braden Scale were found to significantly contribute to risk for pressure ulcer development in this sample: moisture, nutrition, and friction and shear. Therefore a modified Braden Scale was developed, with a possible range of scores from 3 to 11; the cutoff score was 8, sensitivity was 52%, and specificity 66%. CONCLUSIONS: The mean prevalence rate of 12% was comparable, and the incidence rate of 6% for this unit was lower, compared with other skilled care and rehabilitation settings reported in the literature. The proactive, interdisciplinary approach to skin integrity on this unit likely contributed to the lower incidence rate. Risk factors most predictive of pressure ulcer development in this sample were moisture, nutrition, and friction and shear. Predicting risk for skin breakdown with use of a consistent risk-assessment tool is essential for all rehabilitation patients. Assessing risk with the Braden Scale merits further research.

Adult↗
PubMed2005

Predicting the grade of disabilty 1 year after stroke following rehabilitation.

The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6-month follow-up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio-welfare policies for stroke victims.

Aged↗