Effect of age on functional outcomes after stroke rehabilitation

The incidence of stroke and the demand for stroke rehabilitation services continues to increase, and it has been proposed that age be used in combination with severity of stroke to determine type of rehabilitation. It is important to identify the impact of age on functional outcome before embracing a system that limits access to rehabilitation on the basis of age.

This prospective study includes all patients admitted to an inpatient stroke rehabilitation program for 6 years. Demographic and clinical data were extracted by means of chart review. Functional status at admission and discharge was evaluated by means of the FIM instrument. Multivariate regression techniques were used to assess the relationships between age, functional outcome, and other predictive variables. Particular attention was paid to the r(2) values to assess the amount of variation accounted for by the predictors.

Age alone was a significant predictor of total FIM score and Motor FIM score at discharge, but not FIM change. For both total FIM score and Motor FIM score at discharge, age alone accounted for only 3% of the variation in outcome. For all the models, age explained at the most 1.3% of the variation in functional outcome after adjustment for other factors, such as admission FIM score.

The small amount of variation that can be explained by age alone and the questionable clinical relevance of such a small effect suggest that there is no justification to deny patients access to rehabilitation solely because of advanced age.