African Americans and Women have Lower Functional Gains during Acute Inpatient Rehabilitation after Hemorrhagic Stroke

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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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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Length of Stay in In-Patient Rehabilitation after Stroke in Qatar

The Scientific World JOURNAL ◽

10.1100/tsw.2008.81 ◽

2008 ◽

Vol 8 ◽

pp. 547-555

Author(s):

Loganathan Venkatachalm ◽

Ana Bobinac Georgievski ◽

Wafaa Al Yazeedi ◽

Rajvir Singh ◽

Hilda Uribazo Garrido

Keyword(s):

Length Of Stay ◽

Hemorrhagic Stroke ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Significant Negative Correlation ◽

Multivariate Regression Analysis ◽

Functional Independence ◽

Medical Rehabilitation ◽

Rehabilitation Unit ◽

Disability Scale

The objective of this study was to analyze the factors predicting length of stay in a stroke patient rehabilitation unit at Hamad Medical Corporation (HMC) in Qatar. The medical rehabilitation data of 100 stroke patients discharged from a 15-bed inpatient rehabilitation unit (IPRU) were collected retrospectively from medical records during the period from September 2004 to April 2007. A questionnaire was developed, and variables included in the study were age of the patient, length of stay in acute care (LOSa), length of stay in rehabilitation (LOSr), functional independence measure on admission and discharge (FIMa and FIMd), modified disability scale, and modified mobility scale. Patients were grouped by impairments defined by cause as ischemic or hemorrhagic stroke, and right or left body side deficit. A significant negative correlation was observed between LOSr and FIMa (r= −0.44,p= 0.00), and positive correlation between LOSr and LOSa (r= 0.37,p= 0.00). There was no correlation between LOSr and FIMd (r= −0.03,p= 0.76). We observed that low admission FIMa and FIMd were related to extended LOS in both acute and IPRU. Multivariate regression analysis was performed by taking age, LOSa, cause of hemorrhage or ischemia, and FIMa as independent variables, and LOSr as dependent variable. The model could explain only 26% variation for LOSr. This study supports the hypothesis of an association between LOSr, LOSa, and FIMa. Further research is needed to confirm the results of this and other similar studies.

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Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/154596839901300310 ◽

1999 ◽

Vol 13 (3) ◽

pp. 199-203 ◽

Cited By ~ 9

Author(s):

John G. Schmidt ◽

Jessie Drew-Cates ◽

Mary L. Dombovy

Keyword(s):

Functional Outcome ◽

Hemorrhagic Stroke ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Efficiency Score ◽

Poor Functional Outcome ◽

Rehabilitation Unit ◽

Home Setting ◽

Severe Stroke ◽

Acute Rehabilitation

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

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Functional Outcome of Ischemic and Hemorrhagic Stroke Patients After Inpatient Rehabilitation

Stroke ◽

10.1161/01.str.0000102902.39759.d3 ◽

2003 ◽

Vol 34 (12) ◽

pp. 2861-2865 ◽

Cited By ~ 126

Author(s):

Stefano Paolucci ◽

Gabriella Antonucci ◽

Maria Grazia Grasso ◽

Maura Bragoni ◽

Paola Coiro ◽

...

Keyword(s):

Functional Outcome ◽

Hemorrhagic Stroke ◽

Inpatient Rehabilitation ◽

Stroke Patients

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POSTER BOARD T24: AFRICAN AMERICANS WITH MULTIPLE SCLEROSIS ON DISEASE MODIFYING AGENTS AND THEIR EFFECTS ON FUNCTIONAL STATUS IN AN INPATIENT REHABILITATION SETTING

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/00002060-200603000-00058 ◽

2006 ◽

Vol 85 (3) ◽

pp. 259

Author(s):

Ray Lee ◽

Patrick J. Barrett ◽

Michelle Gittler ◽

Dezheng Huo

Keyword(s):

Multiple Sclerosis ◽

African Americans ◽

Functional Status ◽

Inpatient Rehabilitation ◽

Disease Modifying ◽

Disease Modifying Agents

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Abstract T P129: Depression Differs by Race among Stroke Survivors Receiving Inpatient Rehabilitation

Stroke ◽

10.1161/str.46.suppl_1.tp129 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Gabrielle M Harris ◽

J. George Thomas ◽

Vu Nguyen ◽

Mark A Hirsch ◽

Tami Guerrier ◽

...

Keyword(s):

African American ◽

African Americans ◽

Alaska Native ◽

Negative Impact ◽

Inpatient Rehabilitation ◽

Stroke Survivors ◽

Rehabilitation Care ◽

Mortality And Morbidity ◽

Post Stroke ◽

Race Ethnicity

Background: Depression is associated with increased mortality and morbidity post-stroke and can adversely impact functional recovery. To-date, studies of depression among stroke survivors receiving inpatient rehabilitation have not examined whether the prevalence differs by race. Methods: This retrospective cohort study included patients who received inpatient rehabilitation care after an acute stroke in 2009-2011 at one of three facilities that are part of a comprehensive health system. Presence of depressive symptomology either pre- or post-stroke was identified in the neuropsychological assessment or discharge summary. Absence of documentation of depression, depression symptomology or challenges with adjustment was coded for analyses as “no depression.” Descriptive analyses compared presence of depression by race (White, African American, or Other Race/Ethnicity including American Indian, Alaska Native, Asian, Hispanic/Latino, Native Hawaiian/Other Pacific Islander). Patient characteristics were examined to describe depressed patients of each race. Results: Among 1491 stroke survivors (61.2% White, 34.0% African American, 4.8% other race/ethnicity), 29.7% had documentation of depression. Difference by race was significant (p<0.001). Prevalence of depression was highest (34.9%) among Whites (38.0% pre-morbid). Depression was documented among 22.1% of African Americans (33.0% pre-morbid). Only 16.9% of other race/ethnicity patients had depression and all were new onset post-stroke (no pre-morbid depression). Compared to those without depression pre- or post-stroke, it was more common for Whites and African Americans with depression (but not patients of other race/ethnicity) to be younger and female. Differences by stroke type, days since onset, impairment group, medical comorbidities, post-stroke complications and deficits were not statistically significant. Conclusion: Depression was documented in almost a third of stroke survivors who received inpatient rehabilitation, and highest among Whites compared with African Americans and patients of other race/ethnicity. Outcomes research by race is needed and exploration of how rehabilitation care can be modified to minimize any negative impact of depression.

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