Turkish Journal of Physical Medicine and Rehabilitation 2008 , Vol 54 , Num 4

Functional Disability Level in Patients with Stroke in Early Stage: The Relationship with Functional Gai

Altınay Göksel Karatepe 1 ,Rezzan Günaydın 2 ,Aylin Demirhan 3 ,Taciser Kaya 1 ,Muhteşem Gedizlioğlu 4
1 İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, İzmir, Türkiye
2 İzmir Bozkaya Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniği, İzmir
3 Sağlık Bakanlığı İzmir Eğitim ve Araştırma Hastanesi, Fizik Tedavi ve Rehabilitasyon Kliniği, İzmir
4 Sağlık Bakanlığı İzmir Eğitim ve Araştırma Hastanesi, Nöroloji Kliniği, İzmir

Objective: This study was designed to establish the determinants of functional disability level and to investigate the relationship between functional disability level at the baseline and functional gain in patients with stroke at early period.

Materials and Methods: Eighty patients who had their first stroke were enrolled in the study. Age, sex, location and type of the lesion were documented for each patient. The disease severity was assessed by the Canadian Neurological Scale. Functional disability levels of patients were determined by Functional Independence Measure (FIM) at the baseline and after a four weeks home exercise program. Functional gain was calculated by substracting the baseline FIM scores from the control FIM scores. Patients were divided into three groups according to baseline functional independence measure scores as patients with scores of ≤36, scores of 37–72 and scores of ≥73. 

Results: Significant improvement was observed in FIM scores of patients at the control examination (83.89±33.98) compared to baseline (53.18±29.31) (p<0.000). The mean functional gains of cases were 30.7±25.2. It was observed that baseline FIM score was the best predictor of control FIM score. Baseline FIM score explained 48% of control FIM score [b=0.502, p=0.001, (95 % CI 0.223–0.781)]. Patients with scores of 37–72 according to baseline FIM scores had markedly higher functional gain scores (45.6±23.1) than patients with scores of ≤36 (24.8±25.5) or patients with score of ≥73 (16.7±11.5) (F=13.5, p=0.000).

Conclusion: In this study, it was determined that baseline FIM scores were the best predictor of functional disability, and also patients with moderate lel of disability according to baseline FIM scores had higher functional gain. Patients with moderate level of FIM scores at the baseline should be admitted intensive rehabilitation programs, because these patients will provide higher benefit from the rehabilitation and could have higher functional gain. 

Keywords : Functional gain, functional independence measure, stroke