BACKGROUND: A good motor outcome after stroke is often equated with independence in functional performance. However, for patients with severe motor disability a good outcome is unlikely, but an important change may be achievable. OBJECTIVE: Determine if patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function. METHODS: A prospective observational study of 239 patients with stroke admitted to inpatient rehabilitation in Brisbane, Australia was conducted. On admission and discharge, participants were assessed using the motor items of the Functional Independence Measure (m-FIM). The importance of change achieved on the m-FIM was evaluated according to: 1) a statistical significant outcome; 2) achievement of a MCID based on a physician-anchored rating of change; and 3) shift in disability status e.g., severe to moderate disability. RESULTS: Patients with severe motor disability achieved a significant improvement in motor function (p < 0.001), which saw up to 83% achieve a MCID and 85% shift out of 'severe' to either moderate or mild motor disability on discharge from inpatient rehabilitation. CONCLUSION: This study demonstrates that patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function on discharge from inpatient rehabilitation.