Predictors of Functional Recovery After Stroke in 2014 and 2024: A Retrospective Study From a Portuguese Reference Rehabilitation Center

BackgroundStroke is the leading cause of mortality and disability in Portugal.With population aging and increasing stroke incidence, identifying predictors of functional recovery is essential to guide rehabilitation referral and therapeutic decisions.Age, time to rehabilitation admission, admission functional status, aphasia, neglect, and National Institutes of Health Stroke Scale score have been proposed as predictors of recovery.This study aimed to identify clinical and demographic predictors of Functional Independence Measure (FIM) gain in patients undergoing inpatient post-stroke rehabilitation a decade apart, assess their influence on functional gain, and determine whether these associations changed over time. MethodologyThis retrospective, single-center study included 226 patients admitted to the Centro de Medicina de Reabilitação de Alcoitão in 2014 (138, 61%) and 2024 (88, 39%).Demographic and clinical variables included sex, age, premorbid autonomy, education, previous stroke, stroke subtype, acute hospital complications, referral source, time to rehabilitation admission, length of stay, aphasia, neglect, admission Functional Ambulation Categories (FAC), and admission and discharge FIM scores.Generalized linear models assessed associations between selected variables and FIM gain.The prespecified analysis included 217 complete cases (2014, n = 132; 2024, n = 85).FIM gain was subsequently modelled using significant predictors from each year to assess changes in their associations over the decade. ResultsThe cohorts were comparable regarding demographic characteristics, premorbid functional status, stroke type, length of stay, and functional status at admission and discharge.Compared with 2014, patients admitted in 2024 were more frequently referred from hospitals, had a longer time from stroke to rehabilitation admission, and had a higher prevalence of neglect.In multivariable analyses, female sex, longer time to admission, and higher admission FAC were independently associated with lower FIM gain in 2014, whereas aphasia was associated with greater gain.In 2024, hospital referral was associated with greater FIM gain, while acute hospital complications and higher admission FAC were associated with lower gain.FIM gain was 16.95 in 2014 and 14.10 in 2024. ConclusionsFactors associated with FIM gain differed over the decade.Female sex and delayed rehabilitation admission predicted lower gain in 2014, whereas aphasia predicted greater gain.In 2024, hospital referral predicted greater gain and acute hospital complications predicted lower gain.Higher admission FAC was consistently associated with lower FIM gain, although this finding warrants cautious interpretation.Limitations include the retrospective single-center design, selection of patients eligible for intensive rehabilitation, and the absence of stroke severity and other relevant clinical variables.Prospective studies incorporating these factors, rehabilitation intensity, and long-term outcomes are needed.