scholarly journals Sex Differences in Stroke Rehabilitation Care in Alberta

2020 ◽  
Vol 47 (4) ◽  
pp. 494-503
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Stroke Rehabilitation ◽  
Living Arrangement ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
The Impact

ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.

scholarly journals Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

2019 ◽  
Vol 46 (6) ◽  
pp. 691-701
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Severe Stroke ◽  
Rehabilitation Care ◽  
Mild Stroke ◽  
The Impact ◽  
Functional Gains

ABSTRACT:Background:We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.Methods:Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.Results:The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10–9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10–9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10–9, partial η2 0.022) and LOS (p = 1.1 × 10–19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.Conclusion:Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

2001 ◽  
Vol 10 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Jan Coleman Gross ◽  
Stacey W. Goodrich ◽  
Mary E. Kain ◽  
Elizabeth A. Faulkner
Keyword(s):  
Nursing Care ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Two Factors ◽  
Staffing Needs ◽  
Care Index ◽  
Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

The Current State of Stroke Rehabilitation in Japan

1999 ◽  
Vol 13 (4) ◽  
pp. 219-223
Author(s):  
Yoshihisa Masakado ◽  
Naoichi Chino
Keyword(s):  
Regression Analysis ◽  
Chronic Conditions ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Current State ◽  
Rehabilitation System

This paper presents the current state of stroke rehabilitation in Japan. The Japanese rehabilitation system is much different from those in other countries, mainly because of the Japanese insurance system, which covers from acute to chronic conditions. In this situation, a Japanese inpatient stroke rehabilitation program treats patients until they reach a plateau in impairment and disability. Thus we can evaluate the true func tional prognosis because of longer periods of observation for assessing the recovery pat tern of impairment and disability. As a result, we can predict stroke outcome much more precisely. We recently developed a new evaluation methods for stroke patients called the Stroke Impairment Assessment Set (SIAS) based on work from the Sym posium on Methodologic Issues in Stroke Outcome Research in 1989. Using the SIAS and the Functional Independence Measure, we have successfully predicted stroke out come using regression analysis.

Abstract NS13: Road to Recovery after Stroke: Understanding Predictors of Discharge Destination, Functional Independence, and Quality of Life after Hospital Discharge

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Pamela Roberts ◽  
Harriet Aronow ◽  
Sonia Guerra ◽  
Tingjian Yan
Keyword(s):  
Quality Of Life ◽  
Comparative Effectiveness ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Functional Scores ◽  
Brain Involvement

Introduction: Stroke is the leading cause of long-term disability and affects 795,000 people in the U.S. each year. This study was conducted to enhance knowledge of outcomes during recovery and the options for participating in rehabilitation and preventive care during patients’ transitions to the community. Comprehensive Stroke Certification charges hospitals with the task of expanding knowledge of functional and quality of life outcomes for all stroke patients through the continuum examining effects of stroke severity, functional impairment, and patient characteristics on discharge destinations, functional independence, and quality of life after discharge. Methods: Retrospective analysis of an acute stroke quality improvement database which includes measures collected by MedTel Outcomes LLC on all stroke patients one month after discharge. Included, is the Functional Independence Measure and standardized quality of life and participation measures. In the database are standardized measures from the medical record such stroke type, Modified Rankin score, and acute functional independence measure score for 719 patients with a 30-day follow-up phone assessment for functional and quality of life measures from January 1, 2011 to December 31, 2012. Preliminary Findings: Over 75% of patients had hemiparesis, & over 90% survived 30-days post discharge and were living in the community. At follow-up, mostwere independent in self-care, and half were independent in mobility excluding stairs. Those with right brain involvement had a complicated, slower recovery. Those with left brain involvement,had lower functional scores and a higher percentage of them were not living in the community, rather, living in institutions. Conclusions: All patients experiencing a stroke should have evidence-based information on their options & what to expect during their recovery during their transitions into the community. The data base is useful as a source of outcome data for comparative effectiveness and to build a regional collaborative outcomes database for Comparative Effectiveness Research and quality benchmarking. Findings can be used to understand the functional trajectory of recovery based on severity of stroke and other factors.

Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Nneka Ifejika ◽  
Linda Aramburo-Maldonado ◽  
Chunyan Cai ◽  
Melvin R Sline ◽  
Elizabeth A Noser ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Assisted Living ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Advanced Age ◽  
Nursing Facilities ◽  
Stroke Patients ◽  
Home Discharge

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P<0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P<0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P<0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P<0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P<0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P<0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P<0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P<0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

scholarly journals Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older

2016 ◽  
Vol 96 (9) ◽  
pp. 1381-1388 ◽  
Author(s):  
Suzanne R. O'Brien ◽  
Ying Xue
Keyword(s):  
Outcome Measures ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Functional Independence ◽  
Assessment Instrument ◽  
Age Group ◽  
Cross Sectional ◽  
Discharge Outcomes

Abstract Background In the United States, people 85 years of age or older have a growing number of strokes each year, and this age group is most at risk for disability. Inpatient rehabilitation facilities (IRFs) adhere closest to post-acute stroke rehabilitation guidelines and have the most desirable outcomes compared with skilled nursing facilities. As stroke is one of the leading causes of disability, knowledge of postrehabilitation outcomes is needed for this age group, although at present such information is limited. Objective The purpose of this study was to describe functional and discharge outcomes after IRF rehabilitation in people with stroke aged 85 years or older. Design A serial, cross-sectional design was used. Methods Inpatient Rehabilitation Facility–Patient Assessment Instrument data were analyzed beginning in 2002 for the first 5.5 years after implementation of the prospective payment system and included 71,652 cases. Discharge function, measured using the Functional Independence Measure (FIM), and community discharge were the discharge outcome measures. Sample description used frequencies and means. Generalized estimating equations (GEEs) with post hoc testing were used to analyze the annual trends for discharge FIM and community discharge by age group (85–89, 90–94, 95–99, and ≥100 years). Risk-adjusted linear and logistic GEE models, with control for cluster, were used to analyze the association between both outcome measures and age group. Results Over 5.5 years, mean discharge FIM scores decreased by 3.6 points, and mean achievement of community discharge decreased 5.5%. Approximately 54% of the sample achieved community discharge. Continuous and logistic GEEs revealed factors associated with discharge outcomes. Limitations Results obtained using an observational design should not be viewed as indicating causation. The lack of control for a caregiver may have altered results. Conclusions The very elderly people admitted to IRF stroke rehabilitation made functional gains, and most were able to return to the community.

scholarly journals Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

2021 ◽  
Author(s):  
Ayaka Matsumoto ◽  
Yoshihiro Yoshimura ◽  
Fumihiko Nagano ◽  
Takahiro Bise ◽  
Yoshifumi Kido ◽  
...  
Keyword(s):  
Energy Intake ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Length Of Hospital Stay ◽  
Functional Independence ◽  
Potentially Inappropriate Medications ◽  
Negatively Associated ◽  
Home Discharge ◽  
The Impact ◽  
Inappropriate Medications

Abstract BackgroundEvidence is scarce regarding the polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine.AimTo investigate the prevalence and impact on outcomes of polypharmacy and PIMs in stroke rehabilitation.MethodsA retrospective cohort study was conducted with 849 older inpatients after stroke.Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included Functional Independence Measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay and the rate of home discharge. To consider the impact of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes.ResultsAfter enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = -0.072, P = 0.017), FIM-cognitive score (β = -0.077, P = 0.011), energy intake (β = -0.147, P = 0.004), and home discharge (OR: 0.499; 95% CI: 0.280, 0.802; P = 0.015). PIMs were negatively associated with energy intake (β = -0.066, P = 0.042) and home discharge (OR: 0.452; 95% CI: 0.215, 0.756; P = 0.005).ConclusionsPolypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy and PIMs are negatively associated with outcomes.

scholarly journals Evaluation of sensorimotor reactions during early rehabilitation for patients after cerebral stroke

Medicina ◽  
2007 ◽  
Vol 43 (12) ◽  
pp. 942
Author(s):  
Daiva Petruševičienė ◽  
Raimondas Savickas ◽  
Aleksandras Kriščiūnas
Keyword(s):  
Early Stage ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Early Rehabilitation ◽  
Point Of View ◽  
Functional Improvement ◽  
Cerebral Stroke ◽  
Stroke Patients ◽  
Functional Changes

Early inpatient rehabilitation is extremely important in functional improvement of patients suffering from cerebral stroke. From our point of view, in rehabilitation of patients after cerebral stroke, the estimation of sensorimotor reactions that enables the evaluation of sensorimotor functional changes is highly relevant. The article describes the comparison of sensorimotor reactions in two subgroups – stroke patients and healthy individuals – by applying Sensoneck system. The evaluation was performed before early stage of rehabilitation and thereafter (following early rehabilitation). In order to estimate the correlation between changes in functional independence and sensorimotor reactions, Functional Independence Measure was used. The study revealed that stroke patients had sensorimotor dysfunctions. During early rehabilitation, the quality of motion performance improved slightly, and sensorimotor reactions improved statistically significantly (P<0.05). The relationship between Functional Independence Measure and Sensoneck scores was not significant (P>0.05).

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