Recovery and rehabilitation following subarachnoid haemorrhage. Part I: outcome after inpatient rehabilitation

Abstract

Background and purpose: Although subarachnoid haemorrhage (SAH) is a subtype of stroke, functional outcome following rehabilitation for SAH must be considered distinct from that of cerebral infarction because of the younger age and the difference in pathology and resultant neurologic deficits. The purposes of this study were to: (1) describe the demographic and clinical characteristics of SAH patients receiving rehabilitation; (2) describe functional outcomes following inpatient rehabilitation; and (3) investigate possible relationships between patient characteristics and functional outcomes. Methods : Retrospective chart review of SAH patients admitted to inpatient rehabilitation. Functional Outcomes rated by the Functional Independence Measures (FIM). Analysis with descriptive and nonparametric statistics. Results : Eighty patients with SAH admitted to a rehabilitation unit with a mean age of 54 years. Fifty-seven had identified aneurysms as a cause of SAH. Seventy-four subjects (93%) presented with Hunt and Hess grades of 3-5. The median length of stay was 26 days in acute care and 49 days in rehabili tation. Seventy patients (88%) were discharged home. The mean admission FIM was 59.5 and mean discharge FIM 91.0. The FIM efficiency (aggregate change in FIM/day) was 0.62/day and the average rate of FIM gain 0.97 points/day. Hydrocephalus negatively influenced outcome (p = 0.05). There was a trend for subjects with worse Hunt and Hess scores at onset to have poorer discharge FIM scores. Conclusion : SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed.