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Stroke. 2017 Dec;48(12):3308-3315. doi: 10.1161/STROKEAHA.117.018058. Epub 2017 Oct 19.

Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation: The Maugeri Model.

Author information

1
From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of Physiatry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy (M.P.). domenico.scrutinio@icsmaugeri.it.
2
From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of Physiatry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy (M.P.).

Abstract

BACKGROUND AND PURPOSE:

Prediction of outcome after stroke rehabilitation may help clinicians in decision-making and planning rehabilitation care. We developed and validated a predictive tool to estimate the probability of achieving improvement in physical functioning (model 1) and a level of independence requiring no more than supervision (model 2) after stroke rehabilitation.

METHODS:

The models were derived from 717 patients admitted for stroke rehabilitation. We used multivariable logistic regression analysis to build each model. Then, each model was prospectively validated in 875 patients.

RESULTS:

Model 1 included age, time from stroke occurrence to rehabilitation admission, admission motor and cognitive Functional Independence Measure scores, and neglect. Model 2 included age, male gender, time since stroke onset, and admission motor and cognitive Functional Independence Measure score. Both models demonstrated excellent discrimination. In the derivation cohort, the area under the curve was 0.883 (95% confidence intervals, 0.858-0.910) for model 1 and 0.913 (95% confidence intervals, 0.884-0.942) for model 2. The Hosmer-Lemeshow χ2 was 4.12 (P=0.249) and 1.20 (P=0.754), respectively. In the validation cohort, the area under the curve was 0.866 (95% confidence intervals, 0.840-0.892) for model 1 and 0.850 (95% confidence intervals, 0.815-0.885) for model 2. The Hosmer-Lemeshow χ2 was 8.86 (P=0.115) and 34.50 (P=0.001), respectively. Both improvement in physical functioning (hazard ratios, 0.43; 0.25-0.71; P=0.001) and a level of independence requiring no more than supervision (hazard ratios, 0.32; 0.14-0.68; P=0.004) were independently associated with improved 4-year survival. A calculator is freely available for download at https://goo.gl/fEAp81.

CONCLUSIONS:

This study provides researchers and clinicians with an easy-to-use, accurate, and validated predictive tool for potential application in rehabilitation research and stroke management.

KEYWORDS:

activities of daily living; confidence intervals; probability; rehabilitation research; stroke rehabilitation

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