Ann Rehabil Med.  2018 Oct;42(5):670-681. 10.5535/arm.2018.42.5.670.

Long-Term Outcomes of FIM Motor Items Predicted From Acute Stage NIHSS of Patients With Middle Cerebral Artery Infarct

• Saito J
• Koyama T
• Domen K

• KMID: 2429196
• DOI: http://doi.org/10.5535/arm.2018.42.5.670

Abstract

OBJECTIVE
To outline the association between the National Institutes of Health Stroke Scale (NIHSS) in the acute stage and the Functional Independence Measure (FIM) of motor items several months later.
METHODS
Seventy-nine infarct cases with middle-cerebral-artery region transferred to long-term rehabilitation facilities were analyzed. Patients were allocated to either the model-development group or the confirmatory group at a 2:1 ratio. Independent variables were based on the NIHSS during the acute care and on demographic factors such as age and modified Rankin Scale (mRS) before onset. Multivariate logistic analyses were performed to predict the independence of each FIM motor item. These models were evaluated in the confirmatory group.
RESULTS
Multivariate logistic analyses in the model-development group (n=53) indicated that at least one NIHSS item was statistically significantly associated with the functional independence of a single FIM motor item. Of the NIHSS items, the affected lower extremity item was the most widely associated with 11 of the FIM motor items, except for eating and shower transfer. The affected upper extremity function was the second widely involved factor associated with 7 of the FIM motor items including eating, grooming, bathing, toileting, bed transfer, toilet transfer, and shower transfer. Age and mRS were also statistically significant contributing factors. The obtained predictive models were assessed in the confirmatory group (n=26); these were successful except for the stairs climb item.
CONCLUSION
In combination with age and pre-stroke status, the NIHSS items (especially the affected extremity items) may be useful for the prediction of long-term outcome in terms of activities in daily living.

Keyword

Rehabilitation; NIHSS; FIM; Prediction; Middle cerebral artery infarction

MeSH Terms

Animals
Baths
Demography
Eating
Extremities
Grooming
Humans
Infarction, Middle Cerebral Artery
Lower Extremity
Middle Cerebral Artery*
National Institutes of Health (U.S.)
Rehabilitation
Stroke
Upper Extremity

Figure

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  Fig. 1. Method of changing ordinary variables of the National Institutes of Health Stroke Scale (NIHSS) item into multiple dichotomous variables.

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  Fig. 2. Flow diagram of patients included and excluded in the study. MCA, middle cerebral artery.

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  Fig. 3. Scatter diagrams showing the total score of the National Institutes of Health Stroke Scale on the x-axis, and independence or dependence of Functional Independence Measure defined in the text on the y-axis in 53 patients of the model-development group (1=independence, 0=dependence).

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  Fig. 4. Example of logistic curve obtained from multivariate logistic model (bed transfer). The model equation is as follows: 19.63-(0.20×Age)-(3.39×Affected Upper Extremity 3rd)-(3.91×Affected Lower Extremity 2nd). Zero in the horizontal axis indicates a logistic probability 0.50. The curve showed the probability of bed transfer independence. The distance from the bottom to the top of the graph curve is the probability of independence.

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