Article

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 DischargeFIM 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 AdmissionFIM scores and presence of a caregiver, whereas better FIM
effectiveness was correlated with higher motor AdmissionFIM 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. TO
CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at
http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this
article, the learner will be able to: (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; and (3) Utilize factors associated with functional
improvements in recurrent strokes in treatment planning. LEVEL: Advanced
ACCREDITATION: : The Association of Academic Physiatrists is accredited by the
Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians. The Association of Academic Physiatrists
designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s).
Physicians should only claim credit commensurate with the extent of their
participation in the activity.

Langue : ANGLAIS