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European Journal of Physical and Rehabilitation Medicine 2015 October;51(5):597-606


lingua: Inglese

General cognition predicts post-stroke recovery defined through minimal clinically important difference (MCID): a cohort study in an Italian rehabilitation clinic

Ginex V. 1, Vanacore N. 2, Lacorte E. 2, Sozzi M. 1, Pisani L. 1, Corbo M. 1, Clerici F. 3

1 Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy; 2 National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy; 3 Center for Research and Treatment of Cognitive Dysfunctions, Institute of Clinical Neurology, Luigi Sacco Hospital, University of Milan, Milan, Italy


BACKGROUND: In the field of rehabilitation it is crucial to define if changes in functional scores correspond to relevant clinical improvements.
AIM: To assess whether cognition affects motor recovery in post-stroke patients using a clinical meaningful criterion: the minimal clinically important difference (MCID).
DESIGN: Retrospective cohort study.
SETTING: Inpatient rehabilitation clinic.
POPULATION: Two hundred nine first-ever stroke patients undergoing a post-acute inpatient rehabilitation.
METHODS: Cognitive status was assessed with the cognitive FIM and the Mini-Mental State Examination (MMSE). The response to the rehabilitation was defined as the achievement of the MCID between admission and discharge in the motor FIM (responder) and both in the motor and in the cognitive FIM (best-responder).
RESULTS: Subjects with a baseline higher MMSE>24.9 had a near four-fold higher probability of being responder (OR 3.91; 95% CI 1.72-8.89) and a two-fold higher probability of being best-responder (OR 2.69; 95% CI 1.24-5.84) on motor FIM as compared to those with a MMSE≤24.9. A duration of the rehabilitation of 55-61 days implies a three-fold higher probability (OR 3.17; 95% CI 1.15-8.72) to be responder as compared to shorter period of treatment; a treatment >61 days does not involve a greater probability of response.
CONCLUSIONS: This is the first study that examined post-stroke motor recovery mainly in terms of clinical relevance (MCID). Subjects with a higher cognitive level are more likely to achieve a clinically meaningful recovery.
CLINICAL REHABILITATION IMPACT: MCID can be applied extensively to post-stroke patients undergoing to an inpatient rehabilitation in order to have a clinically useful instrument that assess the recovery.

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