Background: Large studies evaluating the long-term trajectories and correlates of functional gain among Intracerebral hemorrhage (ICH) survivors, particularly across the transition from the Functional Independence Measure (FIM) to Section GG scores, are lacking. Methods: We analyzed 22-year trends (2002–2025) in functional recovery among ICH survivors across a multicenter inpatient rehabilitation network. Linear regression models were used to estimate factors associated with functional gain, defined as discharge minus admission scores, in FIM-Motor (January 2002–September 2019), Section GG (October 2019–August 2025), and FIM-Cognitive (2002-2025) scores, adjusting for demographics, comorbidities, baseline function, therapy duration, and insurance. Adjusted β coefficients and 95% CIs are reported. Results: Overall, 2,846 patients were included (mean age 59.6±15.5 years; 41.6% female; 41.1% Non-Hispanic White NHW). In the FIM era (n=1,735), the mean motor gain was 19.4±12.3, with no significant yearly trend (β, 95% CI: 0.07, –0.09 to 0.24). Non-Medicare vs. Medicare Fee-for-service (3.13, 1.39–4.88) and longer therapy duration (0.16 points per hour, 0.10–0.22) were associated with greater motor gain, while older (–0.08 per year, –0.16 to –0.01) and Non-Hispanic Black (NHB) vs. NHW patients (–1.67; 95% CI, –3.10 to –0.24), and those admitted with pressure ulcers (–9.70; 95% CI, –12.78 to –6.63) had lower motor gains. In the Section GG era (n=1,111), the average functional gain was 16.5±13.4 points, with a significant yearly increase (0.50, 0.05, 0.96). Factors associated with greater functional gain included higher admission GG score (0.31, 0.21–0.40) and greater therapy duration (0.55 points per hour, 0.47–0.62). Across the entire study period, mean FIM cognitive gain was 4.8 points with a declining trend (-0.06, -0.10 to -0.012). Non-Medicare insurance (0.91, 0.40–1.42) and therapy duration (0.018 points per hour, 0.006–0.036) were associated with greater cognitive gain. Conversely, NHB vs. NHW patients (–0.91, –1.32 to –0.49), those admitted with pressure ulcers (–1.68, –2.39 to –0.98), and older patients (–0.03, –0.05 to –0.006) had lower cognitive gain. Conclusions: The consistent influence of therapy, insurance, age, race, and complications highlights both modifiable and systemic drivers of recovery and provides evidence to guide rehabilitation planning and policies to improve equity and quality in post-acute stroke care.
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