Scrutinio Domenico, Monitillo Vincenzo, Guida Pietro, Nardulli Roberto, Multari Vincenzo, Monitillo Francesco, Calabrese Gianluigi, Fiore Pietro
From the Department of Cardiology and Cardiac Rehabilitation (D.S., P.G., F.M.) and Department of Neurorehabilitation (V. Monitillo, R.N., V. Multari), "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy; Department of Neurorehabilitation, "S. Maugeri" Foundation, Marina di Ginosa, Taranto, Italy (G.C.); and Department of Neuroscience and Sense Organs, Physical Medicine and Rehabilitation, University of Bari, Italy (P.F.).
Stroke. 2015 Oct;46(10):2976-80. doi: 10.1161/STROKEAHA.115.010440. Epub 2015 Sep 3.
Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk.
The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality.
Age (P<0.001), marital status (P=0.003), time from stroke onset to rehabilitation admission (P<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R2 of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain.
Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR.
预测卒中康复（SR）后的功能结局是一个日益受到关注的领域。SR与生存率之间的关联仍不明确。我们试图研究与SR后功能结局相关的因素，以及康复所实现的功能改善程度是否与长期死亡风险相关。
研究人群包括722例在卒中发作90天内入院接受SR的患者，入院时功能独立性测量（FIM）评分<80分。我们使用单变量和多变量线性回归分析来评估基线变量与FIM改善之间的关联，并使用单变量和多变量Cox分析来评估FIM改善与长期死亡率之间的关联。
年龄（P<0.001）、婚姻状况（P=0.003）、从卒中发作到康复入院的时间（P<0.001）、康复入院时的美国国立卫生研究院卒中量表评分（P<0.001）和失语症（P=0.021）与FIM改善独立相关。该模型的R2为0.275。在中位随访6.17年期间，36.9%的患者死亡。在多变量Cox分析中，年龄（P<0.0001）、冠心病（P=0.018）、心房颤动（P=0.042）、总胆固醇（P=0.015）和FIM总改善（P<0.0001）与死亡率独立相关。随着FIM改善三分位数的增加，调整后的死亡风险比显著降低。
几个因素与SR后的功能改善独立相关。我们的研究结果强烈表明，功能改善程度是接受SR治疗患者长期死亡率的有力预测指标。
