The aims of this study were: (1) to identify reliable prognostic factors for detecting subgroups of no, low and high response in consecutive patients admitted for rehabilitation of first stroke sequelae, and (2) to quantify the relative risk of poor or excellent prognosis on both Activities of Daily Living (ADL) and mobility for each significant variable. We prospectively studied 440 of 475 patients. From a group of 32 independent variables, those significantly associated with no, low and high effectiveness on both ADL and mobility were selected by means of multiple regression; then, the relative risk was calculated for each variable that significantly entered the multiple regressions. Patients with severe impairment or with global aphasia showed a relative risk of no response 4–6 times higher than that of other patients. An interval before rehabilitation longer than 2 months was associated with an increasing risk of no response. Elderly patients had a significantly higher relative risk of low response both on ADL and mobility. The presence of hemineglect and depression was associated with an increasing risk of low response on ADL but not on mobility. The absence of hemineglect and a short interval are prerequisites for an excellent functional prognosis on both ADL and mobility. A minor impairment, employed status, the absence of global aphasia and age ≤65 years increased the risk of high response. At the beginning of treatment, clear prognostic factors for the detection of subgroups with poor or excellent rehabilitation prognosis can be identified.

Keywords:
Stroke, Rehabilitation, Functional outcome
1.
Johnston M, Kirshblum S, Zorowitz R, Walker J: Prediction of outcomes following rehabilitation of stroke patients. Neurorehabilitation 1993;2:51–76.
2.
Kotila M, Waltimo O, Niemi ML, Laaksonen R, Lempinen M: The profile of recovery from stroke and factors influencing outcome. Stroke 1984;15:1039–1044.
3.
Denes G, Semenza C, Stoppa E, Lis A: Unilateral spatial neglect and recovery from hemiplegia – a follow up study. Brain 1982;105:543–552.
4.
Feigenson JS, McDowell FH, Meese P, McCarthy ML, Greensberg SD: Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 1. Analysis of 248 unscreened patients. Medical and functional prognostic indicators. Stroke 1977;8:651–656.
5.
Feigenson JS, McCarthy ML, Greensberg SD, Feigenson WD: Factors influencing outcome and length of stay in a stroke rehabilitation unit. Part 2. Comparison of 318 screened and 248 unscreened patients. Stroke 1977;8:657–662.
6.
Galski T, Bruno RL, Zorowitz R, Walker J: Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition. Stroke 1993;24:1794–1800.
7.
Henley S, Pettit S, Todd-Pokropek A, Tupper A: Who goes home? Predictive factors in stroke recovery. J Neurol Neurosurg Psychiatry 1985;48:1–6.
8.
Mills VM, Di Genio M: Functional differences in patients with left or right cerebrovascular accidents. PT 1983;63:481–488.
9.
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808–813.
10.
Paolucci S, Antonucci G, Emberti Gialloreti L, Traballesi M, Lubich S, Pratesi L, Palombi L: Predicting stroke inpatient rehabilitation outcome: the prominent role of neuropsychological disorders. Eur Neurol 1996;36:385–390.
11.
Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E: Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry 1994;57:202–207.
12.
Wade DT, Langton Hewer R, Wood VA: Stroke: Influence of patient’s sex and side of weakness on outcome. Arch Phys Med Rehabil 1984;65:513–516.
13.
Shah S, Vanclay F, Cooper B: Efficiency, effectiveness and duration of stroke rehabilitation. Stroke 1990;21:241–246.
14.
Mahoney F, Barthel DW: Functional evaluation: The Barthel Index. Maryland State Med J Rehabil 1965;14:61–65.
15.
Collen FM, Wade DT, Robb DT, Bradshaw CM: The Rivermead Mobility Index: A further development of the Rivermead Motor Assessment. Int Disabil Stud 1991;13:50–54.
16.
Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB: The stroke data bank: Design, methods, and baseline characteristics. Stroke 1988;19:547–554.
17.
Rocca WA, Hofman A, Brayne C, Breteler MMB, Clarke M, Copeland JRM, Dartigues J-F, Engedal K, Hagnell O, Heeren TJ, Jonker C, Lindesay J, Lobo A, Mann AH, Molsa PK, Morgan K, O’Connor DW, da Silva Droux A, Sulkava R, Kay DWK, Amaducci L, for the EURODEM Prevalence Research Group: Frequency and distribution of Alzheimer’s disease in Europe: A collaborative study of 1980–1990 prevalence findings. Ann Neurol 1991;30:381–390.
18.
Coté R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V: The Canadian Neurological Scale: Validation and reliability assessment. Neurology 1989;39:638–643.
19.
Pizzamiglio L, Judica A, Razzano C, Zoccolotti P: Toward a comprehensive diagnosis of visual-spatial disorders in unilateral brain damaged patients. Psychol Assess 1989;5:199–218.
20.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
21.
Schwartz JA, Speed NM, Brunberg JA, Brewer TL, Brown M, Greden JF: Depression in stroke rehabilitation. Biol Psychiatry 1993;33:694–699.
22.
Pizzamiglio L, Antonucci G, Judica A, Montenero P, Razzano C, Zoccolotti P: Cognitive rehabilitation of the hemineglect disorder in chronic patients with unilateral right brain damage. J Clin Exp Neuropsychol 1992;14:901–923.
23.
Basso A: Approaches to neuropsychological rehabilitation: Language disorders; in Meter MJ, Benson AL, Dialer L (eds): Neuropsychological Rehabilitation. Edinburgh, Churchill Livingstone, 1989, pp 294–314.
24.
Ween JE, Alexander MP, D’Esposito M, Roberts M: Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996;47:388–392.
25.
Whurr R, Lorch MP, Nye C: A meta-analysis of studies carried out between 1946 and 1988 concerned with the efficacy of speech and language therapy treatment for aphasic patients. Eur J Disord Commun 1992;27:1–17.
26.
Wade DT, Wood VA, Langton Hewer R: Recovery after stroke: The first three months. J Neurol Neurosurg Psychiatry 1985;48:7–13.
27.
Paolucci S, Antonucci G, Guariglia C, Magnotti L, Pizzamiglio L, Zoccolotti P: Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: A cross-over study. J Neurol 1996;243:308–314.
28.
Parikh RM, Robinson RG, Lipsey JR, Starstein SE, Fedoroff JP, Price TR: The impact of post-stroke depression on recovery in activities of daily living over a 2-year follow up. Arch Neurol 1990;47:785–790.
29.
Iacoboni M, Padovani A, Di Piero V, Lenzi GL: Post-stroke depression: Relationships with morphological damage and cognition over time. Ital J Neurol Sci 1995;16:209–216.
1998
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