Abstract
Objective
This study explored factors which predict stroke survivors who could achieve “clinically significant functional gain” and return home when being discharged from a local hospital after in-patient stroke rehabilitation programme.
Methods
This study included 562 inpatients with stroke who were residing at community dwellings before onset of stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main outcome variables of prediction were (a) achieving “clinically significant functional gain” as measured by (a1) achievement of “minimal clinically important difference” (MCID) of improvement in Functional Independence Measure Motor Measure (FIM-MM)”, (a2) one or more level(s) of improvement in function group according to the patients’ FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with univariate binary logistic regression and those significant variables were then put into multivariate binary logistic regression.
Results
Based on multivariate regression, the significant predictors for “clinically significant functional gain” were: younger age <75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, intermediate FIM-MM function group. Those significant predictors for “discharge to home” were: living with family/caregivers before stroke, higher FIM score at admission, and one or more level(s) of improvement in FIM-MM function group.
Conclusions
This study identified findings consistent with overseas studies in additional to some new interesting findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to focus on the use of appropriate intervention strategies and pre-discharge preparation.
Introduction
Stroke is a major cause of disability with an indication for long term rehabilitation, which includes an in-patient phase as well as a community phase (Feigin et al., 2003). Despite the incidence rate of stroke in Hong Kong has decreased, the number of stroke survivors remains large due to reduction in mortality rate and population aging (Woo et al., 2014). That implies there is an increasing demand for stroke rehabilitation services. Early and accurate prediction of rehabilitation outcomes, such as discharge destinations, better functional improvement, etc. can facilitate the rehabilitation team to customize their plans of care (e.g. triage to different wards, intensive training versus reinforcing skills of care-givers, etc.) and allow more time for liaison and/or making referrals between transitions of care. Subsequently, it may improve patients’ outcomes, decrease length of stay, lower costs, and, improve utilization of resources (Summers et al., 2009).
Outcomes of stroke are associated with various factors including sociodemographic characteristics, clinical characteristics of the stroke incident, comorbid conditions, functional performance at the beginning of the treatment and rehabilitation process. Previous studies and systematic reviews reported that age, marital status, time from stroke onset to rehabilitation, aphasia, neglect, stroke severity presented in National Institutes of Health Stroke Scale, cognitive function, and motor function such as walking distance were associated with the gain score in Functional Independence Measure (FIM) after stroke rehabilitation (Brown et al., 2015; Fung, 2004; Leung et al., 2010; Meyer et al., 2015; Scrutinio et al., 2015). On the other hand among these variables it was found that functional independence was the most determinant factor of discharge destination in majority of studies (Mees et al., 2016). Furthermore, stroke survivors were more prone to institutional care if they had the characteristics of older age, living alone, having pre-existing comorbidities such as atrial fibrillation, severe stroke, dysphagia, cognitive, motor or functional impairment (Brown et al., 2015; Itaya et al., 2017; Mees et al., 2016; Nguyen et al., 2015). This study aimed to explore if these predictor variables of different aspects stated above showed similar positive association with achievement of clinically significant functional gain and discharge to home for stroke patients in a local rehabilitation hospital.[…]
TBI Rehabilitation 