Toward benchmarks for stroke rehabilitation in Ontario, Canada.

OBJECTIVE: Canadian benchmarking data do not exist for stroke rehabilitation services. This study used the FIM-function-related group (FIM-FRG) classification system to group patients and to describe the outcomes within each group. The intent was to begin to develop benchmarks for persons recovering from stroke in Canadian rehabilitation facilities. DESIGN: 561 patients were stratified into the nine categories of the FIM-FRG system. Length of stay (LOS), total FIM gain, total FIM at discharge, and discharge location were described for each category. RESULTS: Mean waiting time to rehabilitation admission was 29.7 days. Mean LOS was 49.2 days. Mean admission and discharge total FIM ratings were 78.1 and 103.1, respectively. FIM gain ranged from 8 to 37. Seventeen percent of patients were discharged to nursing homes, with rates ranging from a low of 0% (FRG 8 and 9) to a high of 60% (FRG 2). CONCLUSIONS: For the nine FIM-FRG groups, LOS was considerably longer in the Canadian facility than in the United States, and total FIM score at discharge was higher in Canada. This is likely related to differences in the healthcare systems of the two countries and confirms the need to develop benchmarks based on Canadian data.

Indicators of functional status for primary malignant brain tumour patients.

BACKGROUND: We compared the functional status and survival time of patients with malignant gliomas. METHODS: This retrospective review included 143 patients diagnosed with malignant gliomas. Patients were grouped according to histopathological diagnosis. To measure functional status, patients were assigned a Karnofksy performance status (KPS) score at the time of presentation and at one, three, six, nine, 12 months and yearly intervals thereafter. Data were analyzed using descriptive methods as well as Kruskal-Wallis tests, Chi-square tests, Log-Rank tests and Cox's proportional hazards modeling. RESULTS: Eighty-four patients were male. The median age of patients was 63 years. One hundred and seven patients had a histopathological diagnosis of glioblastoma multiforme, 23 of anaplastic astrocytoma and 13 of anaplastic oligodendroglioma. Twenty-nine patients received aggressive multimodal treatment, 83 received intermediate treatment and the remaining 31 patients received conservative therapy. Significant treatment complications occurred in 33% of patients including four post-operative deaths. The anaplastic oligodendroglioma group had lower mortality and maintained better KPS scores over time, as did patients receiving full treatment. The most significant prognostic factors for functional status included age, pretreatment KPS, and type of treatment received. The most significant factors associated with time until death included age, severity of comorbidities, pretreatment KPS, presence of confusion, histopathological diagnosis and type of treatment received. CONCLUSION: In patients with malignant gliomas, younger age, better functional status at presentation and aggressive multimodal treatment were associated with improved longer-term functional status and survival. Confirmation of the effect of multimodal treatment on patient functional status would require a randomised controlled clinical trial.

Effect of age on functional outcomes after stroke rehabilitation.

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.