Examination of follow-up therapy in patients with stroke

Objective: Examine the patterns and effect of follow-up therapy for persons with stroke. Design: Retrospective analysis of national inpatient medical rehabilitation facilities and follow-up survey data from 1994 to 2001. A total of 45,164 patients received inpatient medical rehabilitation after a stroke. The mean age (± standard deviation) was 69.5 (± 12.8) yrs, 48% were women, and 77% were non-Hispanic white. Average length of stay was 21.9 (± 14.2) days. Results: The highest gain in FIM™ instrument ratings for follow-up therapy was associated with a discharge FIM™ rating of ≤65. Patients with FIM™ ratings ≤65 at discharge who received follow-up therapy gained an average of 19.4 points between discharge and follow-up assessment compared with a mean gain of 15.1 points for persons who did not receive follow-up therapy. Validity was examined using 100 bootstrap replications. The percentage of persons with FIM™ instrument scores of ≤65 receiving follow-up therapy increased from 38% in 1994 to 58% in 2001. Conclusions: The differences in postdischarge FIM™ gains between patients with and without follow-up therapy were greatest among patients with discharge FIM™ instrument ratings of ≤65. Compared with patients whose discharge FIM™ ratings were >65, patients with discharge FIM™ scores of ≤65 who underwent follow-up therapy demonstrated substantially greater average postdischarge FIM™ gains than those with FIM™ ratings of >65.