Predicting home discharge after inpatient rehabilitation of stroke patients with aphasia

Background: Hemorrhagic stroke patients may require inter-facility transfer for higher level of care. Limited data are available on outcome of transferred patients. Objective: To determine in-hospital mortality and discharge outcomes among transferred hemorrhagic stroke patients. Methods: Data from all patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of hemorrhagic stroke [intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)] were identified by ICD-9 codes (ICH: 431; SAH: 430). In separate models for ICH and SAH using logistic regression, the odds ratio (OR) and 95% confidence intervals (CI) for in-hospital mortality and good outcome (discharge home or inpatient rehabilitation) among transfer vs. non-transfers were estimated, after adjusting for potential confounders. Results: Of 290,395 patients with ICH, 48,749 (16.8%) arrived by inter-hospital transfer; for SAH, 25,726 (33%) of 78,156 were transfers. In-hospital mortality was lower among ICH transfers (21.2% vs. 23.2%; p=0.004). In adjusted analyses, in-hospital mortality was not significantly different (p=0.20) while discharge to home or inpatient rehabilitation was more likely among transferred ICH patients (OR 1.1, 95% CI 1.0-1.2, p=0.05). In-hospital mortality was lower for SAH transfers (17.4% vs. 22.9%, p<0.001) and remained significant in adjusted analyses (OR 0.7, 95% CI 0.6-0.8). Transferred SAH patients were also more likely to be discharged to home or inpatient rehabilitation (OR 1.2, 95% CI 1.1-1.4, p<0.001). Coiling and clipping procedures were significantly more common in SAH transferred patients while cerebral angiography, mechanical ventilation and gastrostomy were significantly higher in both ICH and SAH transfer patients. Conclusion: While ICH patients arriving by transfer have similar mortality as non-transfers, they are more likely to be discharged to home or acute rehabilitation. For SAH, transfer confers both mortality and outcome benefit. Definitive surgical treatments and aggressive medical supportive care at receiving hospitals may mediate the benefits of inter-hospital transfer in hemorrhagic stroke patients.

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Older Adult Stroke Patients and Their Spousal Caregivers

Families in Society The Journal of Contemporary Social Services ◽

10.1177/104438949407501002 ◽

1994 ◽

Vol 75 (10) ◽

pp. 608-615 ◽

Cited By ~ 13

Author(s):

Janice K. Purk ◽

Rhoda A. Richardson

Keyword(s):

Older Adult ◽

Emotional Functioning ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Spousal Caregivers ◽

Stroke Patients

Using a sample of 44 couples, in each of which one member had suffered a stroke requiring an inpatient rehabilitation stay, the authors examined the morale of stroke patients older than 60 and their spousal caregivers. One hypothesis that guided this research was that the morale levels of older adult stroke patients would correlate with those of their spousal caregivers and with the patient's physical and emotional functioning. Gender and length of time since the stroke were hypothesized to have an effect on morale. Results indicated that morale of caregivers and care receivers were positively correlated. Moreover, functional independence predicted patient and spouse morale levels. Impressions of caregiving and morale of caregivers were correlated. These findings suggest a need to utilize a dyadic approach in research and intervention dealing with stroke patients whose spouses are providing care.

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Poster 99 The Effects of Pre-Morbid Anxiety and Depression on Functional Outcomes in Acute Stroke Patients Admitted to Inpatient Rehabilitation

PM&R ◽

10.1016/j.pmrj.2015.06.138 ◽

2015 ◽

Vol 7 ◽

pp. S123-S124

Author(s):

David B. Essaff ◽

Sarah Ackroyd ◽

Kevin Rhie ◽

Katarzyna B. Iwan ◽

Jennifer Fleeman ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcomes ◽

Inpatient Rehabilitation ◽

Anxiety And Depression ◽

Stroke Patients

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PM&R Consultation for stroke patients in acute care setting may be associated with an increased rate of discharge to the community from the inpatient rehabilitation facility

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000001842 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Farha S. Ikramuddin ◽

AJ Guarino ◽

Erica Siedel ◽

Kathleen Vonderhor ◽

Elizabeth Larson ◽

...

Keyword(s):

Acute Care ◽

Care Setting ◽

Inpatient Rehabilitation ◽

Acute Care Setting ◽

Stroke Patients ◽

Rehabilitation Facility ◽

Inpatient Rehabilitation Facility

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Abstract 2303: Therapeutic Intensity and Functional Gains of Stroke Patients during Inpatient Rehabilitation.

Stroke ◽

10.1161/str.43.suppl_1.a2303 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Hua Wang ◽

Michelle Camicia ◽

Joseph Terdiman ◽

Murali K Mannava ◽

M E Sandel

Keyword(s):

Functional Outcomes ◽

Inpatient Rehabilitation ◽

Functional Improvement ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

The Mean ◽

Total Therapy ◽

Therapeutic Intensity ◽

Functional Gain ◽

Functional Gains

Objectives: To study the effects of therapeutic intensity on functional gains of stroke patients in inpatient rehabilitation. Design: A retrospective cohort study. Setting: An inpatient rehabilitation hospital (IRH) in northern California. Participants: Three hundred and sixty stroke patients discharged from the IRH in 2007. Interventions: Average number of minutes of rehabilitation therapy per day, including physical therapy (PT), occupation therapy (OT), speech language therapy (SLT), and total treatment. Main Outcome Measures: Functional gain measured by the Functional Independence Measure (FIM TM ), including activities of daily living (ADL), mobility, cognition, and total FIM TM scores. Results: The study sample had a mean age of 64.8 years (SD=13.8), and was 57.4% male, and 61.4% White. About three quarter of the patients had an ischemic stroke; 61.4% had one or more significant comorbid conditions. Median IRH length-of-stay (LOS) was 20 days. The mean total therapy time was 190.3 minutes per day (PT 114.0, OT 42.8, and SLT 33.8). The mean total functional gain was 26.0 (ADL 9.1, mobility 11.4, and cognition 6.2). A longer therapeutic duration per day was significantly associated with functional improvement (r=0.20, p<.001). However, patients who received total therapy time of less than 3 hours per day showed significantly lower total functional gain than those treated 3 hours or longer. There was no significant difference in total functional gain between patients treated 3-3.5 hours and over 3.5 hours per day. Intensity of PT, OT, and SLT in hours per day of treatment time was also significantly associated with corresponding sub-scale functional improvements. Figure 1 presents age and gender adjusted therapeutic intensity and FIM TM Gain. Multiple linear regression analyses showed that young age, hemorrhagic stroke, earlier admission to IRH, and longer IRH stay were independent predictors of functional improvement. Conclusions: The study demonstrated a significant relationship between therapeutic intensity and functional gain during IRH stay and provides evidence of treatment intensity thresholds for optimal functional outcomes for stroke patients in inpatient rehabilitation. Key Words: Stroke, rehabilitation therapy, intensity, functional outcomes.

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