Ann Rehabil Med.  2021 Jun;45(3):215-223. 10.5535/arm.20226.

Outcome Prediction for Patients With Ischemic Stroke in Acute Care: New Three-Level Model by Eating and Bladder Functions

• Uchida K
• Uchiyama Y
• Domen K
• Koyama T

• KMID: 2517599
• DOI: http://doi.org/10.5535/arm.20226

Abstract

Objective
To develop a new prediction model by combining independence in eating and bladder management functions, and to assess its utility in an acute care setting.
Methods
Patients with ischemic stroke who were admitted in our acute stroke care unit (n=250) were enrolled in this study. Functional Independence Measure (FIM) scores for eating and bladder management on the initial day of rehabilitative treatment (median, 3 days) were collected as predictive variables. These scores were divided into low (<5) and high (≥5) and categorized as values 0 and 1, respectively. From the simple summation of these two-level model values, we derived a three-level model that categorized the scores as values 0, 1, and 2. The FIM-motor scores at discharge (median, 14 days) were collected as outcome measurements. The three-level model was assessed by observing the distribution patterns of the outcome FIM-motor scores and logistic regression analyses.
Results
The median outcome FIM-motor score was 19 (interquartile range [IQR],13.8–45.3) for the value 0 category (n=14), 66.5 (IQR, 59.5–81.8) for the value 1 category (n=16), and 84 (IQR, 77–89) for the value 2 category (n=95) in the three-level model. Data fitting by logistic regression for FIM-motor scores of 41.3 and 61.4 reached 50% probability of values 1 and 2, respectively.
Conclusion
Despite the simplicity of the three-level model, it may be useful for predicting outcomes of patients with ischemic stroke in acute care.

Keyword

Disability; Measurement; Prognosis; Recovery

Figure

• 

  Fig. 1. Box charts and plots for data distributions of the prediction models derived from Group 1 samples: (A) two-level model eating, (B) two-level model bladder management, and (C) three-level model. Refer to Table 2 for statistical comparisons. Black dots in the value 1 category for the three-level model represent patients who were assigned value 1 in the two-level model bladder management and value 0 in the two-level model eating. FIM, Functional Independence Measure.

• 

  Fig. 2. Logistic probability curves for the relationship between the categories of the prediction models and FIM-motor scores at discharge: (A) two-level model eating, (B) two-level model bladder management, and (C) three-level model. Vertical axes indicate logistic probability and horizontal axes show FIM-motor scores at discharge. (A, B) The distance from the curve to the top of the graph is the probability of the value 1 category. (C) The left curve defines the probability for the value 1 category, and the right curve defines the probability for the value 2 category. FIM, Functional Independence Measure.

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