Measure of Functional Independence Dominates Discharge Outcome Prediction After Inpatient Rehabilitation for Stroke

Once again using totally subjective measurements to predict outcomes rather than objective measures like 3d MRI and PET scans showing the dead and damaged areas. What needs to change to convince them to drop the stupid subjective measures and join the scientific world with objective measures? This a a job for that great stroke association if they accept the job.
http://stroke.ahajournals.org/content/early/2015/02/24/STROKEAHA.114.007392.abstract

1. Allen W. Brown, MD,
2. Terry M. Therneau, PhD,
3. Billie A. Schultz, MD,
4. Paulette M. Niewczyk, PhD, MPH and
5. Carl V. Granger, MD

+ Author Affiliations

1. From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.).

1. Correspondence to Allen W. Brown, MD, Department of Physical Medicine and Rehabilitation, 200 First St SW, Mayo Clinic, Rochester, MN 55905. E-mail brown.allen@mayo.edu

Abstract

Background and Purpose—Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care(maybe call these stroke protocols?) to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge.

Methods—Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home.

Results—The sample included 148 367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r²=0.107). No important additional effect for any other variable was detected when added to this model.

Conclusions—This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set.