Rehabilitation subdirector Clínica Universidad de La Sabana
Objectives Stroke is one of the leading causes of disability and mortality worldwide, with long-term functional limitations that compromise independence and quality of life. Early, structured, and interdisciplinary rehabilitation is essential to optimize recovery and reduce disability. The Process of Interdisciplinary Rehabilitation (PIR®) is designed to provide comprehensive rehabilitation programs tailored to individual needs The purpose of this study was to assess the functional impact of participation in PIR® among patients after stroke, with the Functional Independence Measure (FIM™). Design We conducted a retrospective cohort study of 181 adult post-stroke patients accepted at the PIR® outpatient rehabilitation program between january-2021 and march-2025. All patients were considered eligible for PIR®, but some did not initiate the program due to medical complications or administrative difficulties. Demographic and functional data were collected at baseline and, when applicable, at program completion. Functional independence was measured using the Functional Independence Measure (FIM™). Continuous variables were expressed as medians (IQR), and differences were analyzed with Mann-Whitney U test for non-parametric values and Student’s T-test for parametric values.
Results Of 181 adult patients evaluated, 133 (73%) were enrolled in the PIR®. Median age was 63 years (IQR 43–74), and 49% (n=89) were male. Patients included in the program were younger than those not enrolled (59 [41–71] vs. 65 [56–76], p=0.01). At baseline, FIM™ scores were similar between enrolled and non-enrolled patients (75 [57–97] vs. 69 [48–83], p=0.2). Among those who completed the program, the median duration of participation was 5 months (IQR 3–6). Post-rehabilitation, the FIM™ significantly improved from 75 (57–97) to 94 (74–107), with a median functional gain of 10 points (IQR 4–18; p< 0.001). Non-enrolled patients did not undergo follow-up FIM™ assessments.
Conclusions Participation in the PIR® outpatient rehabilitation program was associated with significant improvements in independence among patients recovering from stroke. These findings highlight the substantial benefits of structured, interdisciplinary rehabilitation in promoting functional recovery and reducing disability, even in populations with complex clinical needs. By integrating medical, therapeutic, and psychosocial interventions under the leadership of physiatrists, PIR® ensures that rehabilitation is individualized, goal-oriented, and family-centered. The program’s structured approach allows patients to regain self-care, mobility, and communication skills, and emotional and social wellness that are essential for daily life and social participation. This evidence reinforces the importance of implementing early, coordinated, and comprehensive rehabilitation models as a cornerstone of stroke care to optimize recovery and long-term outcomes.
Stroke remains one of the leading causes of mortality and disability worldwide, generating a substantial burden on health systems, families, and society. According to the World Health Organization, over 12 million people suffer a stroke annually, and nearly half are left with long-term disability that affects independence and quality of life. The resulting limitations in motor, cognitive, and psychosocial functioning make stroke rehabilitation a cornerstone of recovery strategies.
Rehabilitation post-stroke must be timely, intensive, and interdisciplinary to optimize neuroplasticity, prevent complications, and promote reintegration into daily life. Traditionally, rehabilitation programs vary widely in scope, resources, and outcomes. In this context, structured models such as the Process of Interdisciplinary Rehabilitation (PIR®) have been designed to standardize care, facilitate coordination between professionals, and implement goal-oriented interventions. PIR® led by physical medicine and rehabilitation, integrates expertise of neurologist, psychiatrist, physical-therapists, occupational-therapists, speech and language therapists, psychologists, psychopedagogist, social workers, nurses and other medical professionals to ensure comprehensive management of functional deficits.
The purpose of this study was to assess the functional impact of participation in PIR® among patients after stroke, with the Functional Independence Measure (FIM™). We hypothesized that participation in PIR® would significantly increase functional independence compared to baseline values, underscoring the relevance of structured interdisciplinary rehabilitation.
Methods
Study Design and Population
This retrospective cohort study included 181 adult patients who had suffered a stroke and were evaluated for inclusion in the PIR® outpatient rehabilitation program at Clínica Universidad de La Sabana between January-2021 and March-2025. All patients were deemed eligible for PIR® based on interdisciplinary assessment. However, not all initiated the program due to medical complications or administrative difficulties (e.g., insurance or referral barriers).
Intervention
Patients included in PIR® underwent individualized rehabilitation plans defined by an interdisciplinary team led by a physiatrist. The program included interventions by proffesionals in physiotherapy, occupational therapy, speech and language therapy, psychopedagogy, psychology, neuropsychology, social work and nurses, neurologist, psychiatrist and other medical areas. Treatment goals were tailored to each patient’s deficits and focused on maximizing functional independence, participation, and reintegration into daily activities.
Outcomes
Functional status was measured using the Functional Independence Measure (FIM™). FIM™ scores were obtained at baseline for all patients, and repeated at program completion for those enrolled. The primary outcome was change in total FIM™ score. Secondary outcomes included program adherence (measured by length of participation) and baseline differences between enrolled and non-enrolled patients.
Statistical Analysis
Continuous variables were expressed as median and interquartile range (IQR) due to non-normal distribution. Comparisons between groups were performed using Mann-Whitney U test for non-parametric variables and Student’s T-test for parametric values. Paired comparisons within the same group were analyzed using Wilcoxon signed-rank test. Statistical significance was set at p< 0.05. Data analysis was conducted with RStudio (Version 2024.09.1+394).
Results
Cohort Characteristics
A total of 181 patients were evaluated. Median age was 63 years(IQR 43–74), and 49%(n=89) were male. Of these, 133(73%) initiated the PIR® program, while 48(27%) did not, primarily due to medical complications or administrative difficulties despite being candidates.
Patients included in PIR® were significantly younger than those not enrolled (59 [41–71] vs. 65 [56–76], p=0.01). Baseline FIM™ scores were similar between groups (75 [57–97] vs. 69 [48–83], p=0.2).
Functional Outcomes
Among the 133 patients enrolled in PIR®, the median duration of participation was 5 months(IQR 3–6). At baseline, their FIM™ score was 75(57–97). After completing the program, FIM™ significantly increased to 94(74–107), with a median gain of 10 points (IQR 4–18; p< 0.001).
Non-enrolled patients did not have follow-up FIM™ assessments, preventing direct comparison of outcomes between groups.
Discussion
This study demonstrates that participation in PIR® outpatient rehabilitation program significantly improved functional independence among patients post-stroke. Gains in FIM™ scores highlight the importance of structured, interdisciplinary interventions in promoting recovery and reducing disability.
Relevance of Interdisciplinary Rehabilitation
Stroke recovery is complex and requires coordination of multiple disciplines. PIR® ensures that each patient receives integrated care, addressing motor, cognitive, and psychosocial needs. Evidence suggests that early and intensive rehabilitation maximizes neuroplasticity, and our results support this by showing measurable improvements in functional independence.
The median functional gain of 10 FIM™ points is clinically relevant. Previous studies have established that even modest improvements in FIM™ translate into meaningful changes in daily independence, reducing caregiver burden and healthcare costs. By implementing standardized protocols, PIR® not only enhances outcomes but also ensures continuity and equity of care.
Age and Participation
Interestingly, patients who participated in PIR® were younger than those who didn´t. This may reflect greater resilience, fewer comorbidities, or reduced administrative barriers in younger populations. However, it also underscores the need to ensure equitable access for older patients, who may have the most to gain from structured rehabilitation.
Program Duration
The median program duration of 5 months aligns with international recommendations emphasizing sustained rehabilitation beyond the acute phase. Stroke recovery often extends over months to years, and PIR®’s structure allows continuity of interventions during this critical window.
Limitations
This study has several limitations. First, its retrospective design may be subject to selection bias, particularly since non-enrolled patients were excluded from follow-up evaluations. Second, functional outcomes were measured only with the FIM™; additional measures such as quality of life or participation could provide complementary insights. Finally, generalizability may be limited to similar clinical and health system settings.
Strengths
Despite limitations, this study has important strengths. It included a large cohort of patients systematically evaluated for eligibility. The use of FIM™ as an objective and validated measure adds rigor, while the integration of real-world clinical practice highlights the feasibility of PIR® in daily rehabilitation settings.
Conclusion
Participation in the PIR® interdisciplinary outpatient rehabilitation program resulted in significant improvements in independence and functional outcomes for patients post-stroke. These findings reinforce the effectiveness of structured, goal-oriented rehabilitation in reducing disability and promoting recovery.
Implementation of standardized programs such as PIR® should be encouraged as part of national strategies for stroke management. Future prospective studies with longer follow-up and broader outcome measures are needed to confirm these benefits and explore their long-term impact on reintegration, caregiver burden, and healthcare utilization.
