A descriptive study of variables explaining functional recovery following stroke

Stroke is the third leading cause of death in the United States and a leading cause of disability in the rapidly aging population. Great strides have been made in the past two decades in decreasing stroke mortality during the acute phase, and currently 70% of patients return home following an acute stroke. Clinicians and researchers now need to focus on these stroke survivors and identify where to concentrate efforts during the acute phase of care in order to optimize the functional recovery of the patient. This prospective correlational study, based on the Roy Adaptation Model (RAM), described a cohort of subjects with a motor stroke and assessed the extent to which selected variables measured during the acute phase explained the variation in functional recovery post stroke. Data were collected from a convenience sample of 100 consenting adults recruited during admission to neurology services at two large urban medical centers. Age, lesion volume, motor strength, cognitive status, and post-stroke functional level data were collected during the acute care hospital admission. Subjects mean age was 65 years (SD ± 15, range = 20–90), the mean lesion volume in centimeters cubed (cm3) was 21.5 ( SD ± 44.7, range = 0–225) and the mean National Institute of Health Stroke Scale (NIHSS) was 6.34 (SD ± 3.55, range = 2–17). Cognitive status was measured using two instruments. The mean Mini-Mental Status Examination (MMSE) score was 24.3 (SD ± 13, range = 9–30) while the mean Neurobehavioral Cognitive Status Examination (NCSE) was 64.33 (SD ± 13, range = 12–85). The mean Functional Independence Measure (FIM) score was 94.05 (SD ± 19.31, range = 38–120). Ninety subjects were available three months post stroke when functional recovery was measured. The Mean FIM score at that time was 117 (SD ± 13). The RAM, as well as the review of the clinical stroke literature helped guide the identification of the contextual variables of age, cognitive status, post-stroke functional level and the focal variables of lesion volume and motor strength. The results of the multiple regression analysis revealed that the key contextual variables accounted for 42% of the variance in functional recovery three months after stroke. The two focal variables did not enter the hierarchical regression model. Thus, in addition to providing a description of a group of individuals who had a motor stroke, the results of this study will help clinicians appropriately focus their time and attention during the fast paced acute phase of stroke care