Determining cut-off points in functional assessment scales in stroke.

BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.

Study of the Recovery Patterns of Elderly Subacute Stroke Patients in an Interdisciplinary Neurorehabilitation Unit.

BACKGROUND: This study seeks to establish the facts of the improvement over time in elderly poststroke patients. METHODS: A retrospective study was performed with regard to 106 subacute stroke patients aged older than 65 years, who were treated in an interdisciplinary neurorehabilitation unit. Three assessment points were established (on admission, 6 months post-onset, and 12 months post-onset), with the scores relative to 10 assessment scales having been collected at each point. RESULTS: By means of a principal component analysis, a first component was obtained, which is taken to represent a combined index of the 10 scales and to express the overall health status of the patient. An analysis of variance of this first component enabled a clear improvement trend to be identified, with this being more marked during the first 6-month period (72.7%) than the second 6-month period (27.3%). CONCLUSIONS: The elderly stroke patients underwent an interdisciplinary rehabilitation program lasting 1 year, experimented an initial period of rapid recovery during the first 6 months followed by a less marked period of improvement. However, no stabilization period in the patients' progress was found.