ADL Outcome of Stroke by Stroke Type and Time from Onset to Admission to a Comprehensive Inpatient Rehabilitation Ward

Introduction: We examined patient characteristics associated with cognitive improvement during inpatient rehabilitation. Methods: This was a retrospective review of clinical data from inpatient stroke rehabilitation units collected from 9/2017- 8/2019. Multiple and logistic regressions were used to examine the relationship between demographics, vascular risk factors and cognitive Functional Independence Measure (FIM) change scores on comprehension, expression, social interaction, problem solving, and memory in stroke patients, adjusted for cognitive FIM scores on admission. Results: The study cohort consisted of 680 patients with a mean age of 68 ± 14 years and median hospital LOS of 15 days. The percentage of patients that improved on comprehension, expression, social interaction, problem solving, and memory FIM scores was 61%, 65%, 62%, 64%, and 64%, respectively. Multiple regression analysis indicated that predictors of cognitive recovery included hypertension, stroke type, age, and NIHSS score. Specifically, hypertension predicted significantly less improvement on problem solving FIM scores (p=.033). Intracerebral hemorrhage (ICH) predicted significantly greater improvement on comprehension and problem solving FIM scores as compared to ischemic stroke (p=.047, p=.032, respectively). Compared to age < 65, age ≥ 65 predicted less improvement on comprehension, expression, and memory FIM scores (p<.001, p=.003, p<.001, respectively). NIHSS scores ≥ 21 predicted less improvement on comprehension, expression and problem solving FIM scores than NIHSS scores < 20 (p=.013, p=.017, p=.005, respectively). Logistic regression analysis suggested that the odds of cognitive improvement (defined as at least three FIM score changes ≥2) for ICH was 1.7 times greater than ischemic stroke (95% CI 1.07-2.72; Table 1). Conclusion: Hypertension, stroke type, age, and NIHSS score have profound impacts on cognitive recovery in during inpatient rehabilitation.

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Abstract TP160: What Matters Most? Predictors of Poststroke Functional Outcomes From Inpatient Rehabilitation Facilities Across the United States

Stroke ◽

10.1161/str.51.suppl_1.tp160 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

James J García ◽

Karlita L Warren ◽

Fengmei Gong ◽

Honggang Wang

Keyword(s):

United States ◽

Length Of Stay ◽

Functional Outcomes ◽

Inpatient Rehabilitation ◽

The United States ◽

Sociodemographic Factors ◽

Administrative Database ◽

Cross Sectional ◽

Rehabilitation Facilities ◽

Stroke Type

Introduction: Stroke is one of the leading cause of disability and death in the United States (Benjamin et al., 2018). Inpatient rehabilitation is the gold standard treatment for post-acute care (Weinstein et al., 2016). Data indicate a discharge to inpatient rehabilitation facilities (IRFs) following the acute stroke phase has increased (Buntin, Colla, & Escarce, 2009). The inpatient milieu provides a unique opportunity to examine predictors of functional outcomes using a captive sample. Thus, the current study aim is to identify factors associated with poststroke functional outcomes throughout inpatient rehabilitation. Method: This is a cross-sectional and retrospective analysis of data extracted from an administrative database during years 2005-2016 from 244,286 stroke patients across 30% of IRFs in the U.S. Inclusion criteria were patients at or above the age 18 with stroke as an admitting diagnosis using ICD 9/10 codes 430-438/I60-I69. Dependent variables were: admission Total FIM, Total FIM efficiency, discharge Total FIM, and length of stay (LOS). Results: Using separate regression analyses, marital status, admit year, type of admission, race/ethnicity, insurance type, sex, age, number of complications, number of comorbidities, and stroke type, emerged as significant predictors of functional outcomes throughout inpatient rehabilitation. Moreover, those with greater comorbidities and complications were associated with lower admission FIM total score, less total FIM efficiency, lower discharge FIM total score, and a longer LOS. Compared to NHWs, racial/ethnic people were associated with lower FIM scores throughout inpatient rehabilitation and a longer length of stay. Discussion: In this robust national dataset, data indicate clinical and sociodemographic factors are significantly associated with poststroke functional outcomes throughout inpatient rehabilitation. Implications are discussed within a framework of social determinants of health.

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99 Safer Mobility: Practice vs Preach

Age and Ageing ◽

10.1093/ageing/afz103.59 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Sive Carey ◽

Adefunke Salawu ◽

Marian Glynn

Keyword(s):

Physical Activity ◽

Inpatient Rehabilitation ◽

Geriatric Rehabilitation ◽

Activity Levels ◽

Ward Staff ◽

Rehabilitation Team ◽

Staff Members ◽

Ward Level ◽

Rehabilitation Ward ◽

Mobility Status

Abstract Background Activity levels in older people undergoing inpatient rehabilitation are low. Intervention by the rehabilitation team amounts to 2% of a patient’s day. Interdisciplinary working helps to ensure that therapy continues beyond the physiotherapy gym. However, safe handling is required. Aims Examine the awareness of ward staff of the mobility status of their patients. Investigate if staff on a general geriatric rehabilitation ward are compliant with physiotherapy mobility recommendations. Methods Data collection took place on a general geriatric rehabilitation ward from February to March 2019. Staff Awareness was assessed by individually asking ward staff (Nurses and Health Care Assistants) to identify the mobility status of their patients. Their responses were recorded and compared with the physiotherapy mobility recommendations as per the MDT (multi-disciplinary) communication whiteboard. The mobility status of each patient was observed by means of random visual audits. Observations were recorded and subsequently compared to the physiotherapy mobility recommendations as above for compliance. Results For the staff awareness audit, 95 responses were obtained from 10 different staff members. 50.5% of responses (n=48) correctly identified patients’ mobility status. 49.5% (n=47) incorrectly identified patients’ mobility status. From 10 visual audits, a total of 196 patient observations were recorded. In 37.2% (n=73) of observations, patients were not mobilising as per physiotherapy recommendations. 39.3% (n=77) of observations were as recommended. In 23.5% (n=46) of observations, patients were not mobilised at all. Conclusion There was limited awareness among ward staff of the mobility status of their patients. Over 1/3 of patients were not mobilised as per physiotherapy recommendations. These findings can compromise both patient and staff safety. The visual audit also highlighted low physical activity levels in some patients. Implications for clinical practice include the need for education on safer mobility and the promotion of patient physical activity at ward level. Physiotherapy led educational and practical handling sessions for ward staff have proven to be beneficial in this regard.

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Having More Daughters Independently Predicts Home Discharge in Stroke Patients Admitted to Inpatient Rehabilitation Ward

International Journal of Gerontology ◽

10.1016/j.ijge.2017.07.005 ◽

2017 ◽

Vol 11 (3) ◽

pp. 197-201

Author(s):

Shiau-Fu Hsieh ◽

Kuo-Liong Chien ◽

Chu-Hao Weng ◽

Yi-Ping Chiang

Keyword(s):

Inpatient Rehabilitation ◽

Stroke Patients ◽

Home Discharge ◽

Rehabilitation Ward

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9 Patient Outcomes From A General Inpatient Rehabilitation Ward, Does Frailty or Reason for Admission Make A Difference to Patient Outcome?

Age and Ageing ◽

10.1093/ageing/afab028.09 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i1-i6

Author(s):

E Alcorn ◽

L Wentworth

Keyword(s):

Patient Outcomes ◽

Inpatient Rehabilitation ◽

Ageing Population ◽

Pubic Rami ◽

Number Of Patients ◽

Bony Injury ◽

Rehabilitation Ward ◽

Reduced Mobility ◽

Reason For Admission ◽

Frailty Score

Abstract Introduction With our ageing population there is increasing number of patients who experience a decline in their mobility either because of their underlying diagnosis or as a consequence of their hospital stay. There are only a limited number of inpatient rehabilitation beds and it is therefore important to identify those that would benefit the most from inpatient rehabilitation. Method We undertook a retrospective study looking at three months of discharges from an inpatient rehabilitation ward in Manchester. Patients were categorised based on diagnosis (Pubic rami fracture, other fractures, fall with no bony injury and finally medical reasons) and Clinical Frailty Score to see if either had any effect on whether patients mobility improved and to what degree. Results Patients with a reduced mobility on admission were identified and then categorised based on diagnosis. Of those patients admitted with a pubic rami fracture 66.7% improved on the ward with 33.3% of patients reaching their baseline mobility. The mobility of 85.7% of patients with other fractures improved with 42.9% reaching their baseline. Patients admitted following a fall without bony injury showed, 75% improvement with 50% reaching their baseline. Of those admitted for medical reasons 88.9% of those improved but only 22.2% reaching their baseline mobility. The lowest proportion of any category. Those admitted for medical reasons also had the longest median average stay on the rehab ward (33.5 days) followed by other fractures (33 days) then fall with no bony injury (21.5 days) and finally the shortest average stay, pubic rami fractures (20 days). Patients were also grouped occurring to their preadmission Clinical Frailty Score. With the exception of those who scored four (only a small number of patients), there was a negative correlation between an increasing frailty score and the proportion of patients whose mobility improved. However as frailty score increased the proportion of patients who improved to their baseline increased. Conclusion Our study has shown that the majority of patients benefitted from their admission regardless of diagnosis, however those admitted for medical reasons had the lowest chance of reaching their baseline mobility despite the longest admissions on the ward. Further research may be beneficial to investigate if they do better in a different rehabilitation setting.

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Abstract 2224: The Relationship Between Process and Outcomes for Stroke Post Prospective Payment in Inpatient Rehabilitation Facilities

Stroke ◽

10.1161/str.43.suppl_1.a2224 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Suzanne R O'Brien ◽

Gail Ingersoll ◽

Ying Xue ◽

Adam Kelly ◽

Din Chen

Keyword(s):

Inpatient Rehabilitation ◽

Functional Independence ◽

Assessment Instrument ◽

Discharge Destination ◽

Medicare Beneficiaries ◽

Prospective Payment ◽

Rehabilitation Facilities ◽

Race Ethnicity ◽

Stroke Type ◽

The Relationship

Background and Objective: Previous studies have reported decreasing length of stay (LOS) for inpatient rehabilitation facilities (IRFs), with conflicting effects on discharge Functional Independence Measure (FIM) scores and discharge destination (DD). This study was the first to examine the post prospective payment system (PPS) period using Medicare data drawn from the national Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) database. The purposes were to examine trends over time for process and outcome factors, and to describe the relationships between process, LOS, and outcomes (discharge FIM scores and DD), for Medicare patients with stroke. Methods: The study included 371,211 Medicare Part A beneficiaries aged 65 and older with stroke, admitted to United States (US) IRFs between January 1, 2002 and June 30, 2007. Descriptive statistics and generalized estimating equations (GEE) modeling for clustered data were used for analysis. Continuous GEE evaluated LOS and discharge FIM scores, and binomial GEE evaluated LOS and DD (community verses institution). Covariates in models were: admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type. Time interactions with admission FIM scores, LOS, and discharge FIM scores (binomial model only) were examined. Results: During the study period, mean LOS decreased from 17.9 (SD=9.9) to 16.1(SD=8.3) days (p<. 0001), mean discharge FIM scores decreased from 80.1 (SD=24.5) to 76.5 (SD=24.5) points (p<. 0001), and rate of community discharge decreased from 66.6% to 61.2% (p<. 0001). LOS predicted discharge FIM scores (95% CI, .48, .52, p<.0001), but the relationship to community discharge was weak (OR .997, p=.007). Discharge FIM scores predicted discharge destination (OR 1.07, p<.0001). Covariates of admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type also predicted outcomes. Time interactions were present for LOS, admission FIM scores, and discharge FIM scores. Conclusions: During the first 5.5 years of PPS, declining trends were found for LOS, discharge FIM scores, and rate of community discharge for Medicare beneficiaries with stroke. LOS was a strong predictor for discharge FIM scores, but weak for DD. Discharge FIM scores were a better predictor of DD than LOS. Effects of covariates on discharge FIM scores and DD have clinical implications for IRF stroke rehabilitation in the US. Because of the reduced time for treatment, dose of IRF rehabilitation for Medicare beneficiaries may not be achieving expected results in the post-PPS period.

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Abstract P191: A Large Cohort Study Predicting the Temporal Course and Rate of Improvement in Stroke Patients Admitted to Inpatient Rehabilitation Facilities

Stroke ◽

10.1161/str.52.suppl_1.p191 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Shayandokht Taleb ◽

Dorothea Parker ◽

Billie Hsieh ◽

Mohammad H Rahbar ◽

Joseph Wozny ◽

...

Keyword(s):

Goodness Of Fit ◽

Statistical Significance ◽

Age At Onset ◽

Inpatient Rehabilitation ◽

Change Score ◽

Large Cohort ◽

Stroke Severity ◽

Stroke Patients ◽

Rehabilitation Facilities ◽

Stroke Type

Introduction: We sought to predict the course and rate of functional improvement and length of stay (LOS) in patients with ischemic and hemorrhagic strokes admitted to inpatient rehabilitation facilities(IRF). Aim: To study the course and associating factors affecting functional outcomes among a large cohort of stroke patients admitted to IRFs. Methods: The cohort consists of stroke patients admitted to 5 IRFs in Houston, between 4/17-8/19. Higher order polynomial (quartic, cubic, quadratic) regressions were fitted to predict the temporal relationship between FIM score improvement and LOS, and based on goodness of fit statistics, cubic polynomial fit was selected. Effects of interactions were tested and later dropped from the final model because of non-statistical significance. Models were adjusted for age, gender, stroke type (hemorrhagic vs ischemic), and stroke severity based on NIHSS. Results: The demographics of patients are presented in table 1. Among 679 patients, the univariate analyses reflected that age (F=24.2, p <0.001), admission NIHSS score (F=67, p<0.001), stroke type (F=25.2, p <0.001), and admission FIM (F=283, P<0.001) were significant factors predicting IRF LOS. History of previous stroke, diabetes, hypertension, and hyperlipidemia did not have any significant effects on LOS. In multiple regression model, age at onset (β=-0.18, p<0.001), hemorrhagic vs ischemic stroke (β=3.02, p <0.01) were significant predictors of total FIM change score when adjusting for stroke severity and gender. Total FIM change score was positively correlated with LOS at IRF with a steep improvement in the first 15 days of IRF stay which plateaued afterwards in patients with 1-30 days of IRF stay (Fig. 2). Conclusion: Patient’s age, ischemic vs hemorrhagic stroke were the most significant predictors when deriving the relationship between total FIM score and LOS while adjusting for stroke severity and patient’s gender, which plateaued after 2 weeks of IRF stay.

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