The effectiveness of timely thrombolytic therapy in improving recovery following ischemic strokes is generally measured through scales of impairment severity, such as the National Institutes of Health Stroke Scale, (NIHSS), or dichotomized Modified Rankin Scale (MRS). To our knowledge, there is a research gap regarding the effect of thrombolysis on functional outcome gains in an inpatient rehabilitation program, as measured by a person’s independence. The Functional Independence Measure (FIM) is a validated measure of functional recovery that acts as a measure of a person’s independence.
The objective of this study is to evaluate whether thrombolysis for ischemic stroke elicits a greater increase in functional independence in an inpatient rehabilitation program than no thrombolysis. A secondary objective is to determine whether thrombolysis is associated with greater efficiency of functional recovery, and whether age, gender, stroke location, and comorbidity level influence these relationships.
Retrospective chart review was performed on 105 individuals admitted to an in-patient rehabilitation program following ischemic stroke. Both two-tailed t-tests and multiple-regression analysis were performed with thrombolysis administration as the primary variable, with respect to both absolute FIM change, and FIM efficiency. The results were analyzed for interactions with age, gender, stroke location, admitting FIM score, and comorbidities as per the Charlson Comorbidity Index.
Of the 105 patients that were analyzed, 37 received thrombolysis. There were no significant demographic or comorbidity differences between the group that received thrombolysis and the group that did not. There was no significant interaction between thrombolysis administration and absolute change in FIM score (p = 0.252, CI -1.80 to 6.81). The interaction between thrombolysis and FIM efficiency trended towards significance, with thrombolysis potentially increasing FIM efficiency (p = 0.069, CI -0.0252 to 0.6530). Neither relationships had significant interactions with the above demographic variables listed.
Thrombolysis administration does not affect magnitude of functional recovery obtained in a rehabilitation program, regardless of age, gender, stroke location, or comorbidities. This suggests that the positive effects of thrombolysis on recovery from stroke manifest only acutely after administration. Possibly, further larger prospective studies could elucidate a positive relationship between thrombolysis administration and FIM Efficiency.