Predictive model of functional independence in stroke patients admitted to a rehabilitation programme

To develop a prognostic model to estimate the probability of patients being independent in ambulation and in activities of daily living (ADL) after six months of stroke.

Cohort analytical study.

Rehabilitation departments of two district general hospitals.

Ninety-two consecutive stroke patients admitted to a rehabilitation programme.

Independent ambulation was defined as a Functional Ambulation Classification (FAC) > or =4, and the independence in ADL as a Barthel Index (BI) > or =285. All patients were assessed on admission to rehabilitation, and in the first, second, third, fourth and six months after stroke.

Prognostic factors were identified by means of a multivariate survival analysis using Cox regression. Three variables were predictors for a FAC > or =4: (1) The patients in the motor (M), motor-sensitive (MS) and motor-sensitive with hemianopsia (MSH) groups (relative risk (RR) 5.43 of M with respect to MSH, and 2.41 of MS to MSH). (2) A Motricity Index >25 (RR 3.19). (3) An age <70 years old (RR 1.99). For a BI > or =85 three predictors were selected: (1) The classification M-MS-MSH (RR 6.02 M to MSH, and 1.52 MS to MSH). (2) An initial BI >20 (RR 3.45); the highest contribution in the achievement of an initial BI >20 was bowel and bladder continence. (3) The antecedent of previous independence (RR 2.68). The predictive models, constructed by means of multiple logistic regression correctly classified 77% and 79% of the patients who obtained FAC > or =4 and a BI > or =85 respectively.

The syndromic classification M, MS and MSH, together with other routinely available data, such as the Motricity Index, BI, the age and the previous functionality, can be used to obtain a patient prognosis level with regard to ambulation and ADL independence.