in the western countries , stroke is the third leading cause of death , the second cause of dementia and the first leading cause of disability in adults . in switzerland , the incidence is about 200 cases per 100,000 patients per year , about half of them survive with a relatively severe disability . in western countries , it has been shown that total long - term costs of a stroke patient can rise up to eur 228,038 . the high prevalence of stroke and the high direct and indirect costs it generates make the management of stroke patients a national healthcare priority . despite the progress made in the acute management of stroke patients , neurorehabilitation remains the main method of treatment in the management of stroke patients with neurological deficits . moreover , the prevalence of risk factors for stroke is expected to rise  as is the survival of stroke patients . a recent study has also shown a trend towards increasing stroke incidence at younger ages ( age 20 - 54 years ) during the past decade . furthermore , the rise in neurorehabilitation needs takes place in a context where available resources are limited . the intensity effect between multiprofessional treatment and deficit recovery for neurorehabilitation patients our center guidelines recommend 7 - 10 treatments per week per therapist as the gold standard regarding the management of moderate - to - severe neurological deficit in young patients . moreover , the rehabilitation program ( intensive in - hospital rehabilitation vs. early supported home discharge ) should be different between young active patients and older retired patients regarding needs and goals . therefore , these two groups should also be studied separately . even though there are some factors known to be of bad prognosis in rehabilitation such as age , severity of stroke , bad recovery after 3 months , aphasia , unilateral spatial neglect , very little is known about how these factors influence functional recovery during in - hospital rehabilitation . the actual literature consists mainly of retrospective studies   without patient stratification and inhomogeneous data . the purpose of this study is to point out acute and chronic factors that affect the functional recovery of stroke patients admitted in a high - intensity rehabilitation program and quantify their recovery potential . this will help to plan an appropriate setting for stroke patient rehabilitation programs and provide information on the outcome at an early standpoint , and thus improve the efficiency of rehabilitation units as well as permit a better patients flow coordination . our research consisted of a prospective study including all patients who benefited from an intensive neurorehabilitation treatment with the same rehabilitation team between 2005 and 2010 after a first - ever nontraumatic stroke , and meeting the inclusion criteria described below . it is noteworthy that all included data were routinely acquired in our unit for statistical purpose , and the present study required no additional data exclusively dedicated to the analysis above . the present study has been approved by our local ethical committee ( commission cantonale ( vd ) d'thique de la recherche sur l'tre humain , lausanne , switzerland ) . the population of this study was a selected population as all patients were < 65 years of age . regarding the rehabilitation intensity , patients > 65 years of age were considered unable to undergo the program and were addressed to other rehabilitation centers . furthermore , the rehabilitation potential between young and old patients could vary and mixing both populations could have a bias effect on the statistical results . this affects the mean age of our population , which is almost 15 years younger than in most previous studies . the neurorehabilitation unit of the lausanne university hospital , lausanne , switzerland , admits approximately 130 new patients each year . these criteria were : first ever nontraumatic ischemic or hemorrhagic stroke , age > 65 years , no severe comorbidity such as malignant tumor or a known physical handicap from other etiology , no occurrence of severe complications requiring long - term transfer to another unit and thus interfering with an adequate neurorehabilitation treatment . a stroke rehabilitation registry containing the following items was created : age , sex , presence of known cardiovascular risk factors [ cvrfs ; hypertension ( hbp ) , diabetes ( dm ) , cigarette smoking ( cs ) , hypercholesterolemia ( hc ) ] , presence of other coronary heart disease , other cardiac affection , treatment at time of stroke , stroke etiology ( according to the toast classification ) , stroke type ( ischemic vs. hemorrhagic ) , symptoms after stroke ( motor , sensitive , visual , aphasia , unilateral spatial neglect ) , location ( right , left , both ) , treatment in the acute phase , time interval between stroke onset and rehabilitation admission ( oai ) , occurrence of pain , spasticity , depression and complications ( infection , stroke recurrence , etc . ) during rehabilitation and length of stay ( los ) . the functional independence measure ( fim ) entry and exit scores of all patients the registry also contained the fim delta score ( exit fim - entry fim ) , the fim delta score related to los (  score / los ) , and the relative possible fim gain / week (  entry - exit scores/ 126-entry fim / week ) which is the percentage of potential fim points gained per week of rehabilitation , and thus reflecting recovery velocity . in a previous study , patients that could be discharged home had a median fim of 108.5 . in our opinion , a home discharge is not a relevant item for neurological recovery , as it is biased by the fact that it is strongly dependent on the patient 's social situation and family surrounding . therefore , in the present study , we considered that a fim of > 115 allows autonomy in everyday life ( basic and instrumental activities of daily living ) independent of any familial and social assistance . a total of 172 patients were eligible for the study ; demographic and clinical characteristics are described in table 1 . univariate analysis shows the following results with an fim exit score of > 115 : factors present before admission : age < 55 years ( p = 0.026 ) , gender ( p = 0.070 ) , hbp ( p = 0.529 ) , dm ( p = 0.829 ) , hc ( p = 0.637 ) , cs ( p = 0.035 ) , alcohol ( p = 1.0 ) , coronary heart disease ( p = 0.801 ) , other cardiac diseases ( p = 0.364 ) , at least three cardiovascular risk factors ( p = 0.186 ) , depression before stroke ( p = 0.402 ) , stroke type ( ischemic vs. hemorrhagic , p = 0.271 ) , location ( p = 0.334 ) , aphasia ( p = 0.053 ) , unilateral spatial neglect ( p = 0.001 ) , time from stroke onset to admission ( oai ) ( < or > 14 days , p = 0.005 ) . factors present during rehabilitation : depression ( p < 0.001 ) , pain ( p < 0.001 ) , spasticity ( p < 0.001 ) , complications ( p < 0.001 ) , persistent hbp ( p = 0.788 ) , persistent dm ( p = 0.260 ) , psychotropic medication ( p < 0.001 ) , duration < 70 days ( p < 0.001 ) , fim entry score < 100 ( p < 0.001 ) , and relative possible fim gain / week of < 10% ( p < 0.001 ) . all items with a p value of < 0.2 on the univariate analysis were included in a multiple logistic regression model ( p = 0.05 ) ; the results are shown in table 2 ( factors present before admission ) and table 3 ( factors present during rehabilitation ) . these tables show which variables independently influence the potential of a patient to reach the fim 115 mark during rehabilitation . male gender ( p = 0.011 ) , having an entry fim score of > 100 ( p = 0.000 ) , los of > 70 days ( p = 0.004 ) and relative point gain / week of > 10% ( p = 0.001 ) were identified as positive independent predictors . age of > 55 years ( p = 0.024 ) , aphasia ( p = 0.010 ) , unilateral spatial neglect ( p = 0.013 ) , spasticity ( p = 0.035 ) and complications ( p = 0.003 ) are all negative independent predictors . stroke type , depression , pain and oai of > 14 days do not seem to be independent predictors and have p values of > 0.05 . looking at the odd ratios , two variables stand out : the relative possible fim gain / week of > 10% that reflects the recovery velocity and the entry fim of > 100 . then , we stratified the patients according to their fim entry score into three equivalent groups and calculated the mean entry and exit scores for each group , mean los and percentage of total resource allocations ( total number of rehabilitation days for a group / total number of rehabilitation days for all patients ) . the purpose of the study was to point out some of the predicting factors of a possible discharge home , independently of any social and familial surrounding and of an estimation of the recovery potential of each patient during the early stages of neurorehabilitation . according to our data , the severity of the stroke , reflected by an fim entry score of < 100 , is a crucial determinant in predicting a patient 's potential of reaching a fim exit score of > 115 . then , the velocity of the recovery ( relative fim gain / week > 10% ) is the second most significant individual predictor that has been revealed in this study . this is an important predictor , which can be rapidly assessed after only few weeks of rehabilitation . los > 70 days leads to a higher probability to reach the fim exit mark of 115 . indeed , a significant improvement in the functional fim score can be achieved with a long stay ; in contrast , it implies a substantial increase in costs . this last point is presented in figure 1 . by stratifying the patients into three equivalent groups according to their fim entry score , we showed that group 1 ( lower fim entry score ) needed more than half of the total resources with only a very limited chance of reaching a fim exit score and allowing a home discharge without familial and social assistance . age , gender , aphasia and unilateral spatial neglect have been described in the literature as negative individual predictors in functional recovery after severe stroke in a general population . however , the type of stroke , which is also described as a significant predictor of recovery in the literature , seems to have no significant influence in our population . this can be explained by the age selection of our population , since hemorrhagic strokes occur more often in older patients . in the present study , complication events and the presence of spasticity therefore , special care should be taken for better prevention and treatment of these two factors in the future . based on these results , the items shown to be of a significant predictive value should be considered and lead to the question of the resource allocation . they could be used to guide rehabilitation centers to better select the patients on admission and during the early phase of the rehabilitation program . moreover , it should eventually lead to a new patient management system in which each patient could benefit of a personalized support regarding his individual needs . given the fact that this study concerns a selected younger population , these findings should be considered carefully regarding the general stroke patient population . nevertheless , young stroke patients represent a non - negligible and growing proportion , especially with regard to the social burden of stroke disease .
background / objectivesdespite recent progress in stroke prevention and acute treatment , neurorehabilitation remains one of the main methods of treatment in the management of stroke patients . 
 the aim of this study is to point out some important predicting factors of in - hospital neurorehabilitation outcomes.methodsa rehabilitation registry including all patients who had undergone a standardized program of neurorehabilitation at the neurorehabilitation unit of the lausanne university hospital , lausanne , switzerland , was created . 
 patients aged < 65 years and having experienced a first ever nontraumatic stroke from 2005 to 2010 were admitted . 
 using logistical regression models , predicting factors for each patient were compared to the exit functional independence measure ( fim ) score.resultsage > 55 years , gender , aphasia , hemilateral spatial neglect , spasticity , complications , length of stay > 70 days , entry fim > 100 and relative possible fim gain / week of > 10% were considered to be significant and independent predicting factors of the neurorehabilitation outcome.discussion/conclusionsome factors of the in - hospital rehabilitation period have been identified before ( spasticity , complications , length of stay , relative possible fim gain / week ) and should be considered for a better management of the neurorehabilitation therapy . in addition , a personalized rehabilitation strategy based on the patient 's individual needs should be aimed at . 
 the question of resource allocation can also be addressed with regard to the present findings .