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European Journal of Physical and Rehabilitation Medicine 2019 February;55(1):1-7

DOI: 10.23736/S1973-9087.18.05161-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study

João P. BRANCO 1, 2, 3 , Sandra OLIVEIRA 3, João SARGENTO-FREITAS 1, 4, Jorge LAÍNS 3, João PINHEIRO 2, 4

1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal; 2 Department of Physical and Rehabilitation Medicine, University Hospital Center of Coimbra, Coimbra, Portugal; 3 Department of Physical and Rehabilitation Medicine, Centro de Medicina de Reabilitação da Região Centro, Rovisco Pais, Tocha, Portugal; 4 Department of Neurology, University Hospital Center of Coimbra, Coimbra, Portugal



BACKGROUND: Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established.
AIM: This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery.
DESIGN: Prospective observational study.
SETTING: Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period.
POPULATION: A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old.
METHODS: Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS).
RESULTS: Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS.
CONCLUSIONS: Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program.
CLINICAL REHABILITATION IMPACT: This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.


KEY WORDS: Stroke - Rehabilitation - Upper extremity

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