- Email: [email protected]
Poster 45
E14
2005 ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Objectives: To determine (1) the gender differences in lower leg claudication pain ratings and (2) the major contributors to walking distance in persons with peripheral arterial disease. Design: Descriptive study. Setting: General clinical research center. Participants: Men and women with peripheral arterial disease (PAD; Ankle Brachial Index [ABI] range, 0.9 – 0.3, N⫽14), with a mean age of 74.8⫾6 years. Interventions: Not applicable. Main Outcome Measures: Distance completed during a 6-minute walk test (6MWT), basal oxidative stress levels (plasma lipid hydroperoxides [PEROX]), self-reported lower leg pain ratings [American College of Sports Medicine claudication scale 04], and cardiovascular assessments (blood pressures, heart rate). Results: Right and left ABIs, blood pressures, and heart rates values did not differ between men and women at rest or during the walk test (P⬎.05). 6MWT distances were 349⫾27 and 389⫾27m for men and women, respectively (P⬎.05). Men rated leg pain higher than women at minutes 2 and 4 (1.6 vs 0.71, 2.2 vs 1.1, respectively), and during recovery at minutes 2 and 4 postexercise (2.0 vs 0.25, 1.2 vs 0.2, respectively; P⬍.05). Hierarchal regression analysis revealed that when age and gender were controlled, ABI values, self-reported weight loss within the past 6 months, and basal PEROX were significant contributors to walking distance during the 6MWT in PAD patients (R2⫽.885, P⬍.05). Conclusions: Predictions of physical function in persons with PAD may be achieved using a combination of simple measures such as age, gender, body weight, self-reported weight loss, ABI, and resting blood oxidative stress measures such as PEROX. The factors predicting walk distance that were identified in this cohort may be clinically relevant in understanding initial physical function capabilities and exercise prescriptions for individual PAD patients. Key Words: Claudication; Pain; Peripheral arterial disease; Rehabilitation; Walking.
Poster 43 Comparison of Aerobic Training and Resistance Exercise Training in Patients With Congestive Heart Failure. Wenhui Cao, MD (VA Western New York Healthcare System, Buffalo, NY); Jong-Chaur Shieh, MD; Muzamil I. Rana, MD; Evelyn D. Haberl, NP; Jennifer D. Jones, RN; John Naughton, MD, e-mail: [email protected]. Disclosure: None. Objective: To compare the effect of resistance exercise and aerobic exercise in patients with congestive heart failure (CHF). Design: Randomized controlled study. Setting: Cardiac rehab center at a VA hospital. Participants: 8 subjects randomly assigned to the aerobic training (AT) (n⫽5) group or resistance exercise training (RT) (n⫽3) group. Intervention: Each patient performed prescribed exercise under supervision 3d/wk for 12 weeks. AT group used treadmills, bike, arm weights, and arm ergometer. RT group did resistance exercise of upper and lower extremity with Keiser exercise machine. Main Outcome Measures: The following assessments were done pre and post the 12-week exercise program: exercise stress test, 6 minute walks, 2-dimensional echocardiogram, muscle strength, and endurance testing. Results: For the AT and RT groups, the mean change in muscle strength in triceps, latissimus dorsi, biceps, quads, and hamstring were 24% vs 10.1%, 14.6% vs 13.19%, 31.7% vs 43.4%, 36.1% vs 54.2%, and 28% vs 56.1%, respectively. The mean change in muscle endurance were 63.9% vs 103.2%, 82.7% vs 128.5%, 92.7% vs 140.9%, 62.5% vs 104.4%, and 48.3% vs 297.2%, respectively. The mean change in 6 minute walks was 98.8ft (AT) and 121ft (RT), and in stress testing was 1.63 metabolic equivalents (METS) (AT) vs 0.47 METS (RT). Conclusions: Both aerobic training and resistance exercise training can improve muscle strength and endurance. However, more improvement in muscle strength was seen in lower extremities and improvement in muscle endurance of all 5 muscle groups was more pronounced in the resistance exercise group. The improvement of cardiopulmonary capacity was more significant in the aerobic training group. The combination of aerobic exercise and resistance exercise in a cardiac rehabilitation program can improve cardiopulmonary fitness, and muscle strength and reduce fatigue in CHF patients. Key Words: Aerobic exercise; Congestive heart failure; Rehabilitation; Resistance exercise.
Poster 44 Swallowing Abnormalities and Treatment Strategies Following Cardiac Surgery in Rehabilitation Patients. Noel Rao, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Susan L. Brady, MS; Rachel Caldwell, MS, e-mail: [email protected]. Disclosure: None. Objectives: To identify the incidence of dysphagia following cardiac surgery and to describe the swallowing abnormalities and effective treatment strategies. Setting: Freestanding rehabilitation hospital. Participants: Consecutive admissions following cardiac surgery. Intervention: Videofluoroscopic swallow study (VFSS), fiberoptic nasal endoscopic exam of the swallow (FEES), and dysphagia treatment. Main Outcome Measures: Results of VFSS and FEES, compensatory swallowing strategies, outcome diet, and days of treatment. Results: 92 patients over 18 months were admitted for comprehensive inpatient rehabilitation. 23.9% (22/92) presented with dysphagia and underwent a swallowing exam. Multiple swallowing abnormalities were present in 81.8% (18/22) patients. Aspiration was present 27% (6/22), laryngeal penetration 72.7% (16/22), and pharyngeal residue 77% (17/22). Pharyngeal phase disorders identified for swallowing were swallow response delay 72.7%, reduced base of tongue retraction 59%, reduced pharyngeal sensation 50%, reduced hyolaryngeal elevation/closure 45%, reduced pharyngeal constrictor strength 36%, and reduced laryngeal sensation 27%. Swallow safety positioning/compensatory strategies recommended were multiple swallows 82%, control rate/amount 73%, chin tuck 27%, alternating liquids/ solids 23%, liquid wash 9%, effortful swallow 9%, and throat clear 4.5%. A patient presented with a paralyzed left vocal cord. Multiple swallows were found to be effective 94% of the time when attempted and the use of a chin tuck was found to be effective 54%. Initial diet level was 9 nos per os (NPO) and 13 modified diet. Outcome diet levels were as follows: 1 NPO, 1 therapeutic feedings, 13 modified diet, and 7 regular diet. Days of dysphagia treatment averaged ⫾ SD 10.5⫾6.75 days; number of treatment units (each unit ⫽ 15min) averaged 21.45⫾13.58U. Conclusions: Swallow response delay and reduce base of tongue retraction were the most common pharyngeal phase disorders present. Multiple swallows was the most recommended and effective compensatory strategies to help clear the pharyngeal residue with this patient population. Key Words: Cardiac; Dysphagia; Rehabilitation.
Arch Phys Med Rehabil Vol 86, September 2005
Clinical Outcomes Poster 45 Functional Outcome After Subthalamic Nuclear Deep Brain Stimulation to Treat Parkinson’s Disease: 6-Month Follow-Up. Keith M. Robinson, MD (University of Pennsylvania, Philadelphia, PA); Heather Cianci, MPT; Joseph Noorigian, BA; Jenny M. Acquaviva, MPT; Jurg Jaggi, PhD; Gordon Baltuch, MD, e-mail: [email protected]. Disclosure: None. Objective: To observe functional outcome longitudinally 6 months after subthalamic nuclear deep brain stimulation (STN-DBS) to treat “medically failed” Parkinson’s disease (PD). Design: A within-group longitudinal design that compared presurgical and 6-month postsurgical status and a between-subgroup comparative design that compared those who participated in inpatient rehabilitation and those who did not participate in inpatient rehabilitation, presurgically, and 6 months after STN-DBS. Setting: Urban community hospital within a university-based health system. Participants: 39 subjects with idiopathic PD who were determined candidates for STN-DBS because of failure of medical management. Intervention: Unilateral and bilateral STN-DBS. Main Outcome Measures: FIM instrument, Timed Get Up & Go test under single- and dual-task conditions; multidirectional functional reach test (FRT); and cognitive measures that probed language, visuoperception, executive functions, and working memory. Results: During within group comparisons, significantly improved functional status and static balance was demonstrated 6 months after STN-DBS on the FIM (P⬍.001) and FRT-forward (P⬍.008), respectively. During presurgical between subgroup comparisons, those who participated in inpatient rehabilitation were significantly older (P⬍.009) and had significantly slower speed of information processing on a verbal working memory task (P⬍.05). During the 6-month postsurgical subgroup comparisons, those who participated in inpatient rehabilitation had significantly lower scores on the mobility subscale of the FIM (P⬍.03), and were had significantly slower speed of processing (P⬍.05) and worse performance (P⬍.006) on a verbal working memory task. Conclusions: Overall, functional status and static balance improved 6 months after STN-DBS. The subgroup that required inpatient rehabilitation after STN-DBS were older and had slower cognitive processing. Neither inpatient rehabilitation nor STN-DBS positively influenced this subgroup’s mobility, cognitive processing and working memory 6 months later. Key Words: Deep brain stimulation; Functional outcome; Parkinson’s disease.
Poster 46 Pediatric Risk of Mortality Assessment in Critical Care and Correlation With Functional Outcomes. Gerald H. Clayton, PhD (Children’s Hospital, Denver, CO); Emily Dobyns, MD; Pamela E. Wilson, MD, e-mail: [email protected]. Disclosure: None. Objectives: To evaluate how well assessments of injury severity and mortality risk done in the critical care setting predict functional outcome on discharge for survivors of central nervous system (CNS) injury in the pediatric population and to test the hypothesis that Pediatric Risk of Mortality (PRISM) scores obtained in the critical care setting will predict functional outcome (Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes [FRESNO] scores) on discharge from the hospital. Design: Retrospective study. Setting: Regional tertiary care pediatric hospital with a large inpatient rehabilitation medicine service. Participants: Patients with CNS injury of varied etiology admitted to the pediatric intensive care unit (ICU) and subsequently treated by the inpatient rehabilitation medicine (neurotrauma) service. Interventions: Not applicable. Main Outcome Measures: PRISM and FRESNO assessment tool. Results: The study identified 63 patients ranging in age from 0.7 to 18.3 years which were evaluated using both outcome measures. Identified patients sustained CNS injuries of varying etiology including traumatic brain injury, nonaccidental trauma, anoxic injury, vascular accidents, and others. Analysis of the data revealed no statistically significant correlation between PRISM score on ICU admission and FRESNO score on discharge from the neurotrauma unit. Conclusions: Although PRISM assessment has been demonstrated to adequately predict mortality risk and give some indication of injury severity it does not predict functional level at discharge for survivors. These results point to the need to develop assessment protocols (vs individual tools) that provide accurate information about prognosis from a functional point of view. In addition, approaches should be multidisciplinary and consider both acute and long term outcomes. Key Words: Critical care; Treatment outcome; Neurotrauma; Rehabilitation.
Poster 47 Higher Hematocrit Levels Are Associated With Better Functional Outcome After Ischemic Stroke. Paul T. Diamond, MD (University of Virginia, Charlottesville, VA); Jianfen Shu, MS; Douglas P. Wagner, PhD; Mark R. Conaway, PhD, e-mail: [email protected]. Disclosure: None. Objective: To examine the association between baseline hematocrit (HCT) level and clinical outcome following ischemic stroke. Design: Retrospective analysis of an existing clinical trial database. Setting: Randomized Trial of Tirilizad Mesylate in Acute Stroke (RANTTAS). Participants: 556 subjects, age 18 years or older with ischemic stroke and hemiparesis. Intervention: Separate analyses were done for the Barthel Index, National Institutes of Health Stroke Scale (NIHSS), and Glasgow Outcome Scale (GOS) to assess the relationship between baseline HCT level and the probability of “excellent” and “poor” outcomes. HCT levels were grouped into 4 categories: (1) ⱕ35, (2) 35 to 42, (3) ⬎42 to 47, and (4) ⬎47. The 6 dichotomous outcomes were analyzed relative to the 4 categories of HCT using a 3 degree of freedom 2 test and a 1 degree of freedom test for trend. Main Outcome Measures: Barthel Index, NIHSS, and GOS scores at 3-month follow-up. For the Barthel Index, ⱖ95 was classified as excellent; ⬍60 poor. For the NIHSS, ⱕ1 was excellent; ⬎13 poor. For the GOS, 1 was excellent; ⱖ3 poor. Results: For the Barthel Index and GOS, the associations are statistically significant, with higher HCT levels associated with greater probability of excellent 3-month outcome (2 test, P⫽.003; Cochran-Armitage, P⬍.001) and lower probability of poor 3-month outcome (2 test: Barthel Index, P⫽.03; GOS, P⫽.01; CochranArmitage: Barthel Index, P⫽.002; GOS, P⫽.003). For the NIHSS, the trend test was significant,
2005 ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Objectives: To determine (1) the gender differences in lower leg claudication pain ratings and (2) the major contributors to walking distance in persons with peripheral arterial disease. Design: Descriptive study. Setting: General clinical research center. Participants: Men and women with peripheral arterial disease (PAD; Ankle Brachial Index [ABI] range, 0.9 – 0.3, N⫽14), with a mean age of 74.8⫾6 years. Interventions: Not applicable. Main Outcome Measures: Distance completed during a 6-minute walk test (6MWT), basal oxidative stress levels (plasma lipid hydroperoxides [PEROX]), self-reported lower leg pain ratings [American College of Sports Medicine claudication scale 04], and cardiovascular assessments (blood pressures, heart rate). Results: Right and left ABIs, blood pressures, and heart rates values did not differ between men and women at rest or during the walk test (P⬎.05). 6MWT distances were 349⫾27 and 389⫾27m for men and women, respectively (P⬎.05). Men rated leg pain higher than women at minutes 2 and 4 (1.6 vs 0.71, 2.2 vs 1.1, respectively), and during recovery at minutes 2 and 4 postexercise (2.0 vs 0.25, 1.2 vs 0.2, respectively; P⬍.05). Hierarchal regression analysis revealed that when age and gender were controlled, ABI values, self-reported weight loss within the past 6 months, and basal PEROX were significant contributors to walking distance during the 6MWT in PAD patients (R2⫽.885, P⬍.05). Conclusions: Predictions of physical function in persons with PAD may be achieved using a combination of simple measures such as age, gender, body weight, self-reported weight loss, ABI, and resting blood oxidative stress measures such as PEROX. The factors predicting walk distance that were identified in this cohort may be clinically relevant in understanding initial physical function capabilities and exercise prescriptions for individual PAD patients. Key Words: Claudication; Pain; Peripheral arterial disease; Rehabilitation; Walking.
Poster 43 Comparison of Aerobic Training and Resistance Exercise Training in Patients With Congestive Heart Failure. Wenhui Cao, MD (VA Western New York Healthcare System, Buffalo, NY); Jong-Chaur Shieh, MD; Muzamil I. Rana, MD; Evelyn D. Haberl, NP; Jennifer D. Jones, RN; John Naughton, MD, e-mail: [email protected]. Disclosure: None. Objective: To compare the effect of resistance exercise and aerobic exercise in patients with congestive heart failure (CHF). Design: Randomized controlled study. Setting: Cardiac rehab center at a VA hospital. Participants: 8 subjects randomly assigned to the aerobic training (AT) (n⫽5) group or resistance exercise training (RT) (n⫽3) group. Intervention: Each patient performed prescribed exercise under supervision 3d/wk for 12 weeks. AT group used treadmills, bike, arm weights, and arm ergometer. RT group did resistance exercise of upper and lower extremity with Keiser exercise machine. Main Outcome Measures: The following assessments were done pre and post the 12-week exercise program: exercise stress test, 6 minute walks, 2-dimensional echocardiogram, muscle strength, and endurance testing. Results: For the AT and RT groups, the mean change in muscle strength in triceps, latissimus dorsi, biceps, quads, and hamstring were 24% vs 10.1%, 14.6% vs 13.19%, 31.7% vs 43.4%, 36.1% vs 54.2%, and 28% vs 56.1%, respectively. The mean change in muscle endurance were 63.9% vs 103.2%, 82.7% vs 128.5%, 92.7% vs 140.9%, 62.5% vs 104.4%, and 48.3% vs 297.2%, respectively. The mean change in 6 minute walks was 98.8ft (AT) and 121ft (RT), and in stress testing was 1.63 metabolic equivalents (METS) (AT) vs 0.47 METS (RT). Conclusions: Both aerobic training and resistance exercise training can improve muscle strength and endurance. However, more improvement in muscle strength was seen in lower extremities and improvement in muscle endurance of all 5 muscle groups was more pronounced in the resistance exercise group. The improvement of cardiopulmonary capacity was more significant in the aerobic training group. The combination of aerobic exercise and resistance exercise in a cardiac rehabilitation program can improve cardiopulmonary fitness, and muscle strength and reduce fatigue in CHF patients. Key Words: Aerobic exercise; Congestive heart failure; Rehabilitation; Resistance exercise.
Poster 44 Swallowing Abnormalities and Treatment Strategies Following Cardiac Surgery in Rehabilitation Patients. Noel Rao, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Susan L. Brady, MS; Rachel Caldwell, MS, e-mail: [email protected]. Disclosure: None. Objectives: To identify the incidence of dysphagia following cardiac surgery and to describe the swallowing abnormalities and effective treatment strategies. Setting: Freestanding rehabilitation hospital. Participants: Consecutive admissions following cardiac surgery. Intervention: Videofluoroscopic swallow study (VFSS), fiberoptic nasal endoscopic exam of the swallow (FEES), and dysphagia treatment. Main Outcome Measures: Results of VFSS and FEES, compensatory swallowing strategies, outcome diet, and days of treatment. Results: 92 patients over 18 months were admitted for comprehensive inpatient rehabilitation. 23.9% (22/92) presented with dysphagia and underwent a swallowing exam. Multiple swallowing abnormalities were present in 81.8% (18/22) patients. Aspiration was present 27% (6/22), laryngeal penetration 72.7% (16/22), and pharyngeal residue 77% (17/22). Pharyngeal phase disorders identified for swallowing were swallow response delay 72.7%, reduced base of tongue retraction 59%, reduced pharyngeal sensation 50%, reduced hyolaryngeal elevation/closure 45%, reduced pharyngeal constrictor strength 36%, and reduced laryngeal sensation 27%. Swallow safety positioning/compensatory strategies recommended were multiple swallows 82%, control rate/amount 73%, chin tuck 27%, alternating liquids/ solids 23%, liquid wash 9%, effortful swallow 9%, and throat clear 4.5%. A patient presented with a paralyzed left vocal cord. Multiple swallows were found to be effective 94% of the time when attempted and the use of a chin tuck was found to be effective 54%. Initial diet level was 9 nos per os (NPO) and 13 modified diet. Outcome diet levels were as follows: 1 NPO, 1 therapeutic feedings, 13 modified diet, and 7 regular diet. Days of dysphagia treatment averaged ⫾ SD 10.5⫾6.75 days; number of treatment units (each unit ⫽ 15min) averaged 21.45⫾13.58U. Conclusions: Swallow response delay and reduce base of tongue retraction were the most common pharyngeal phase disorders present. Multiple swallows was the most recommended and effective compensatory strategies to help clear the pharyngeal residue with this patient population. Key Words: Cardiac; Dysphagia; Rehabilitation.
Arch Phys Med Rehabil Vol 86, September 2005
Clinical Outcomes Poster 45 Functional Outcome After Subthalamic Nuclear Deep Brain Stimulation to Treat Parkinson’s Disease: 6-Month Follow-Up. Keith M. Robinson, MD (University of Pennsylvania, Philadelphia, PA); Heather Cianci, MPT; Joseph Noorigian, BA; Jenny M. Acquaviva, MPT; Jurg Jaggi, PhD; Gordon Baltuch, MD, e-mail: [email protected]. Disclosure: None. Objective: To observe functional outcome longitudinally 6 months after subthalamic nuclear deep brain stimulation (STN-DBS) to treat “medically failed” Parkinson’s disease (PD). Design: A within-group longitudinal design that compared presurgical and 6-month postsurgical status and a between-subgroup comparative design that compared those who participated in inpatient rehabilitation and those who did not participate in inpatient rehabilitation, presurgically, and 6 months after STN-DBS. Setting: Urban community hospital within a university-based health system. Participants: 39 subjects with idiopathic PD who were determined candidates for STN-DBS because of failure of medical management. Intervention: Unilateral and bilateral STN-DBS. Main Outcome Measures: FIM instrument, Timed Get Up & Go test under single- and dual-task conditions; multidirectional functional reach test (FRT); and cognitive measures that probed language, visuoperception, executive functions, and working memory. Results: During within group comparisons, significantly improved functional status and static balance was demonstrated 6 months after STN-DBS on the FIM (P⬍.001) and FRT-forward (P⬍.008), respectively. During presurgical between subgroup comparisons, those who participated in inpatient rehabilitation were significantly older (P⬍.009) and had significantly slower speed of information processing on a verbal working memory task (P⬍.05). During the 6-month postsurgical subgroup comparisons, those who participated in inpatient rehabilitation had significantly lower scores on the mobility subscale of the FIM (P⬍.03), and were had significantly slower speed of processing (P⬍.05) and worse performance (P⬍.006) on a verbal working memory task. Conclusions: Overall, functional status and static balance improved 6 months after STN-DBS. The subgroup that required inpatient rehabilitation after STN-DBS were older and had slower cognitive processing. Neither inpatient rehabilitation nor STN-DBS positively influenced this subgroup’s mobility, cognitive processing and working memory 6 months later. Key Words: Deep brain stimulation; Functional outcome; Parkinson’s disease.
Poster 46 Pediatric Risk of Mortality Assessment in Critical Care and Correlation With Functional Outcomes. Gerald H. Clayton, PhD (Children’s Hospital, Denver, CO); Emily Dobyns, MD; Pamela E. Wilson, MD, e-mail: [email protected]. Disclosure: None. Objectives: To evaluate how well assessments of injury severity and mortality risk done in the critical care setting predict functional outcome on discharge for survivors of central nervous system (CNS) injury in the pediatric population and to test the hypothesis that Pediatric Risk of Mortality (PRISM) scores obtained in the critical care setting will predict functional outcome (Functional Rehabilitation Evaluation of Sensori-Neurologic Outcomes [FRESNO] scores) on discharge from the hospital. Design: Retrospective study. Setting: Regional tertiary care pediatric hospital with a large inpatient rehabilitation medicine service. Participants: Patients with CNS injury of varied etiology admitted to the pediatric intensive care unit (ICU) and subsequently treated by the inpatient rehabilitation medicine (neurotrauma) service. Interventions: Not applicable. Main Outcome Measures: PRISM and FRESNO assessment tool. Results: The study identified 63 patients ranging in age from 0.7 to 18.3 years which were evaluated using both outcome measures. Identified patients sustained CNS injuries of varying etiology including traumatic brain injury, nonaccidental trauma, anoxic injury, vascular accidents, and others. Analysis of the data revealed no statistically significant correlation between PRISM score on ICU admission and FRESNO score on discharge from the neurotrauma unit. Conclusions: Although PRISM assessment has been demonstrated to adequately predict mortality risk and give some indication of injury severity it does not predict functional level at discharge for survivors. These results point to the need to develop assessment protocols (vs individual tools) that provide accurate information about prognosis from a functional point of view. In addition, approaches should be multidisciplinary and consider both acute and long term outcomes. Key Words: Critical care; Treatment outcome; Neurotrauma; Rehabilitation.
Poster 47 Higher Hematocrit Levels Are Associated With Better Functional Outcome After Ischemic Stroke. Paul T. Diamond, MD (University of Virginia, Charlottesville, VA); Jianfen Shu, MS; Douglas P. Wagner, PhD; Mark R. Conaway, PhD, e-mail: [email protected]. Disclosure: None. Objective: To examine the association between baseline hematocrit (HCT) level and clinical outcome following ischemic stroke. Design: Retrospective analysis of an existing clinical trial database. Setting: Randomized Trial of Tirilizad Mesylate in Acute Stroke (RANTTAS). Participants: 556 subjects, age 18 years or older with ischemic stroke and hemiparesis. Intervention: Separate analyses were done for the Barthel Index, National Institutes of Health Stroke Scale (NIHSS), and Glasgow Outcome Scale (GOS) to assess the relationship between baseline HCT level and the probability of “excellent” and “poor” outcomes. HCT levels were grouped into 4 categories: (1) ⱕ35, (2) 35 to 42, (3) ⬎42 to 47, and (4) ⬎47. The 6 dichotomous outcomes were analyzed relative to the 4 categories of HCT using a 3 degree of freedom 2 test and a 1 degree of freedom test for trend. Main Outcome Measures: Barthel Index, NIHSS, and GOS scores at 3-month follow-up. For the Barthel Index, ⱖ95 was classified as excellent; ⬍60 poor. For the NIHSS, ⱕ1 was excellent; ⬎13 poor. For the GOS, 1 was excellent; ⱖ3 poor. Results: For the Barthel Index and GOS, the associations are statistically significant, with higher HCT levels associated with greater probability of excellent 3-month outcome (2 test, P⫽.003; Cochran-Armitage, P⬍.001) and lower probability of poor 3-month outcome (2 test: Barthel Index, P⫽.03; GOS, P⫽.01; CochranArmitage: Barthel Index, P⫽.002; GOS, P⫽.003). For the NIHSS, the trend test was significant,