Journal of the American Heart Association · 2026
Eighteen-Year Trends in Motor Recovery During Inpatient Rehabilitation After Ischemic Stroke.
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Bako Abdulaziz, Khan Osman, Larkin Elizabeth, Baig Eman, Juengst Shannon B, Sander Angelle M, Vahidy Farhaan S
Аннотация
BACKGROUND: Trends in functional recovery after ischemic stroke within inpatient rehabilitation settings are not well-described. This study evaluated 18-year trends in functional motor improvement among adults receiving inpatient rehabilitation for ischemic stroke.
METHODS: We conducted a retrospective cohort study of adults with ischemic stroke admitted to a large rehabilitation system from December 2001 to September 2019. The primary outcome was the attainment of a minimal clinically important difference (MCID) in the Functional Independence Measure Motor score, defined as a ≥20-point increase in Functional Independence Measure Motor score. Multivariable logistic regression was used to evaluate temporal trends and their interaction with insurance. Sensitivity analyses evaluated changes in case-mix index, Charlson Comorbidity Index, and length of stay.
RESULTS: Among 9809 ischemic stroke rehabilitation admissions representing 9126 unique patients, 4445 (45.3%) admissions attained MCID. The adjusted odds of MCID attainment increased annually (odds ratio, 1.085 [95% CI, 1.067-1.104]). Model-based predicted probabilities for MCID attainment increased from 0.239 (95% CI, 0.192-0.286) in 2001 to 0.555 (95% CI, 0.509-0.601) in 2019 for Medicare Fee-for-Service and from 0.345 (95% CI, 0.307-0.383) to 0.564 (95% CI, 0.530-0.598) for non-Medicare patients. The year-by-insurance interaction was significant, indicating smaller annual gains for non-Medicare patients (odds ratio, 0.973 [95% CI, 0.953-0.993]; P=0.007). The case-mix index showed no temporal change, while the Charlson Comorbidity Index increased and length of stay declined over time. However, neither the Charlson Comorbidity Index, case-mix index, nor rehabilitation duration explains the temporal improvement in MCID attainment.
CONCLUSIONS: Functional motor recovery improved substantially over 18 years, independent of patient complexity and comorbidity burden, establishing contemporary benchmarks for inpatient stroke rehabilitation outcomes.
METHODS: We conducted a retrospective cohort study of adults with ischemic stroke admitted to a large rehabilitation system from December 2001 to September 2019. The primary outcome was the attainment of a minimal clinically important difference (MCID) in the Functional Independence Measure Motor score, defined as a ≥20-point increase in Functional Independence Measure Motor score. Multivariable logistic regression was used to evaluate temporal trends and their interaction with insurance. Sensitivity analyses evaluated changes in case-mix index, Charlson Comorbidity Index, and length of stay.
RESULTS: Among 9809 ischemic stroke rehabilitation admissions representing 9126 unique patients, 4445 (45.3%) admissions attained MCID. The adjusted odds of MCID attainment increased annually (odds ratio, 1.085 [95% CI, 1.067-1.104]). Model-based predicted probabilities for MCID attainment increased from 0.239 (95% CI, 0.192-0.286) in 2001 to 0.555 (95% CI, 0.509-0.601) in 2019 for Medicare Fee-for-Service and from 0.345 (95% CI, 0.307-0.383) to 0.564 (95% CI, 0.530-0.598) for non-Medicare patients. The year-by-insurance interaction was significant, indicating smaller annual gains for non-Medicare patients (odds ratio, 0.973 [95% CI, 0.953-0.993]; P=0.007). The case-mix index showed no temporal change, while the Charlson Comorbidity Index increased and length of stay declined over time. However, neither the Charlson Comorbidity Index, case-mix index, nor rehabilitation duration explains the temporal improvement in MCID attainment.
CONCLUSIONS: Functional motor recovery improved substantially over 18 years, independent of patient complexity and comorbidity burden, establishing contemporary benchmarks for inpatient stroke rehabilitation outcomes.