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A Retrospective Cohort Comparing Left and Right Middle Cerebral Artery Ischemic Stroke Functional Outcomes in Acute
Craig Rovito1, Albert Park1, Richard Goldstein1
1Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA.
Background:
To date, no large population studies compare left and right middle cerebral artery (MCA) strokes and corresponding patient performance in acute rehabilitation as measured by the Functional Independence Measure (FIM).
Objective:
To compare granular performance data using the six FIM subcategories between left and right MCA territory strokes. This may foster development of individualized rehabilitation programs and affect rehabilitation policy based on phenotypic variations.
Design:
Retrospective cohort study.
Setting:
Inpatient rehabilitation facilities, using Uniform Data System for Medical Rehabilitation data from 2015 to 2017.
Patients:
Individuals with MCA strokes admitted to inpatient rehabilitation facilities (n = 38 812).
Main Outcome Measures:
Mean FIM efficiency and FIM gain within the six FIM subcategories (self-care, sphincter control, transfers, locomotion, communication, and social cognition) were compared between left and right MCA strokes. All were stratified by admission FIM severity categories (<40, 40-80, >80). The study also examined length of stay and percentage discharged to home.
Results:
Mean FIM efficiency was significantly higher for left MCA strokes compared to right MCA strokes. Left MCA strokes with admission FIM <40 and 40-80 had significantly higher FIM efficiencies within the majority of FIM subcategories. However, left and right MCA strokes with admission FIM > 80 did not display any significant differences. Overall, patients with left MCA strokes were discharged to home at a significantly higher percentage. Patients with left MCA strokes with admission FIM 40-80 had on average a 2-day shorter length of stay than those with right MCA strokes.
Conclusions:
Overall, patients with left MCA ischemic strokes had shorter length of stays, higher FIM efficiencies, and larger FIM gains than those with right MCA strokes. These results allow clinicians to counsel patients regarding functional gains based on diagnosis and to tailor rehabilitation programs to impairments encountered in left and right MCA territories. Including laterality of stroke and admission functional status would also improve algorithms for determining reimbursement.
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