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.

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.

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 Correlation of Body Composition and Nutritional Status with Functional Recovery in Stroke Rehabilitation Patients

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1923 ◽  
Author(s):  
Hiroshi Irisawa ◽  
Takashi Mizushima
Keyword(s):  
Nutritional Status ◽  
Muscle Mass ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Risk Index ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Nutritional Risk ◽  
Stroke Patients ◽  
Nutritional Risk Index

Previous studies have suggested that the nutritional status after stroke is independently associated with long-term outcomes and that sarcopenia delays poststroke rehabilitation and worsens the prognosis. However, many stroke patients have a deteriorated nutritional status and a decreased muscle mass in the acute phase. This prospective study included 179 patients who were admitted to the stroke rehabilitation unit. We performed bioelectrical impedance analysis and determined the Geriatric Nutritional Risk Index (GNRI) to assess muscle mass and the nutritional status on admission. Furthermore, we analyzed the activities of daily living using the Functional Independence Measure (FIM) at the time of admission and four weeks later. Furthermore, we evaluated the change in motor FIM items and examined the relationship with the data. Multiple regression analysis revealed that a high muscle rate (skeletal muscle mass/body weight) (odds ratio OR = 2.43), high phase angle (OR = 3.32), and high GNRI (OR = 2.57) were significantly associated with motor FIM items at four weeks in male and female patients. Muscle mass maintenance through nutritional management and early rehabilitation in the acute period of stroke is essential for functional recovery in stroke patients.

Perbedaan Skor Functional Independence Measure (FIM) pada Pasien Rawat Inap dengan Stroke Iskemik dan Stroke Hemoragik di Rumah Sakit di Kota Bengkulu Tahun 2018

2018 ◽  
Vol 1 (3) ◽  
pp. 163-175
Author(s):  
Panji Harry Priya Nugraha ◽  
Suryo Bantolo ◽  
Annelin Kurniati ◽  
Noor Diah Erlinawati ◽  
Ahmad Azmi Nasution
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Functional Independence Measure ◽  
Total Sample ◽  
Functional Independence ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Significant Difference ◽  
Score Gain ◽  
The Difference

Stroke is one of the most common causes of disability in the world. Patients with ischemic stroke have different functional improvements from patients with hemorrhagic stroke. The tool is the Functional Independence Measure (FIM) questionnaire. This study aims to determine the difference in FIM scores in hospitalized patients with ischemic stroke and hemorrhagic stroke at hospitals in Bengkulu City. This research is an observational analytic research with cross-sectional design. The study involved stroke patients who hospitalized at RS Bhayangkara Bengkulu City, RSUD Bengkulu City, and RSUD dr. M. Yunus Bengkulu City from January-April 2018 with total sample 22 ischemic stroke patients and 22 hemorrhagic stroke patients who met the inclusion criteria. FIM scores as independent variables, while the type of stroke as dependent variables. The difference between the two variables was analyzed by unpaired t test and Mann-Whitney test. Patients with ischemic stroke had admission FIM score higher than patients with hemorrhagic stroke (26 vs 13,5; p=0.006). There were no differences in discharge FIM score in patients in both types of stroke (1,67 vs 1,58; p=0,081). There was no difference in FIM score gain between patients with ischemic stroke and patients with hemorrhagic stroke (4,12 vs 4,36; p=0,444). Patients with ischemic stroke had higher admission FIM score compared to patients with hemorrhagic stroke, but there was no significant difference in FIM score gain during hospitalization between ischemic stroke and hemorrhagic stroke patients at hospitals in Bengkulu City.

Abstract TP316: When Push Comes to Shove… Pulling is Better: Achieving Better Outcomes by Actively Seeking (Pulling) Stroke Patients for Rehabilitation

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kien Y Chan ◽  
Andrew S Granger ◽  
Scott Lee
Keyword(s):  
Stroke Rehabilitation ◽  
Discharge Planning ◽  
Functional Independence Measure ◽  
Cost Effective ◽  
Functional Independence ◽  
Acute Hospital ◽  
Financial Benefit ◽  
Stroke Patients ◽  
Rehabilitation Outcome ◽  
Before And After

Background: The length of stay (LOS) of stroke patients in the acute hospital coming to our stroke rehabilitation unit (SRU) has remained largely unchanged despite increasing administrative pressure for earlier discharge in recent years. Reducing this LOS can ease bed pressure and may also improve patient outcome. We explore the effect of changing the model of stroke rehabilitation consultation from patients being referred (or “push”) by the acute team, to the SRU team actively seeking (or “pull”) patients prior to referral. Methods: From November 2010 to December 2011, potential stroke rehabilitation patients were sought daily in targeted wards in Sir Charles Gairdner Hospital (our main referring hospital), lead by a consultant geriatrician. Patients were identified by screening the nurses’ hand over sheet, discussing with the treating medical and allied health team, and reviewing the patients and case notes. Patients were reviewed regularly until their rehabilitation/discharge plan is finalised. The patients’ characteristics and rehabilitation outcome over the two periods before and after service initiation were compared. Results: Over the 14 months, 89 patients were admitted to our SRU, with an average acute hospital LOS of 12.5 days, a 5 days reduction compared to previous years (1996-October 2010: 17.9 days, n=716). The 89 patients were more disabled (average admission functional independence measure [FIM] 69 compare to 73), but with no worsening of outcome (including discharge FIM, FIM efficacy, FIM efficiency, LOS in SRU, % discharged home and mortality). Discussion and Conclusion: The “pull” model in consultation avoids delays from administrative inefficiencies in referring a patient, and allows earlier involvement in discharge planning. This is likely to have contributed to the earlier rehabilitation admission. While this did not change the patients’ outcome, however, the reduction in acute hospital LOS has financial benefit (445 bed days and $800,000 AUD saved over this period). The earlier involvement in patients’ care also facilitates a more seamless transition to rehabilitation. In conclusion, ‘pulling’ patients for stroke rehabilitation is a cost-effective way to reduce LOS in the acute hospital, and may improve rehabilitation outcome.

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.

Chronic Kidney Disease and Functional Outcomes 6 Months after Ischemic Stroke: A Prospective Multicenter Study

2015 ◽  
Vol 46 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Shin Yi Jang ◽  
Min Kyun Sohn ◽  
Jongmin Lee ◽  
Deog Young Kim ◽  
Sam-Gyu Lee ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Stroke Patients ◽  
Nihss Score ◽  
Disease Epidemiology ◽  
Post Stroke ◽  
Obesity Hypertension

Background: The aim of this study was to investigate whether chronic kidney disease (CKD) predicts the outcome of the Functional Independence Measure (FIM) and the Korean version of the modified Barthel Index (K-MBI) 6 months after stroke with adjustment for age, gender, education, smoking, drinking, obesity, hypertension, diabetes mellitus, dyslipidemia, the FIM or K-MBI at discharge and the National Institutes of Health Stroke Scale (NIHSS) score 7 days post stroke. Methods: This study is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation. The sample included 2,037 ischemic stroke patients aged 18 years or older. The FIM and K-MBI scores were assessed at discharge and at 6 months after the onset of stroke. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR <60 ml/min/1.73 m2. Results: Overall, the mean age was 65.5 (±12.4) years. The proportion of men was 62.6%. The proportion of CKD cases was 12.7%. The means of the 6-month FIM and K-MBI were 109.8 (±27.9) and 87.0 (±26.4), respectively. In multiple linear regressions, the 6-month FIM after stroke was significantly associated with CKD (-2.85, p < 0.05), age (-0.29, p < 0.01), the FIM at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.71, p < 0.01). Additionally, the post-stroke 6-month K-MBI was significantly associated with CKD (-2.88, p < 0.01), age (-0.27, p < 0.01), the K-MBI at discharge (0.46, p < 0.01) and the 7-day NIHSS score (-1.55, p < 0.01). Conclusions: This nationwide hospital-based cohort study showed that CKD might predict poor 6-month FIM and K-MBI scores in ischemic stroke patients.

scholarly journals Why Are Stroke Rehabilitation Trial Recruitment Rates in Single Digits?

2021 ◽  
Vol 12 ◽  
Author(s):  
Shashwati Geed ◽  
Preethy Feit ◽  
Dorothy F. Edwards ◽  
Alexander W. Dromerick
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Phase Ii ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
Trial Recruitment ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Post Stroke ◽  
Early Stroke

Background: Recruitment of patients in early subacute rehabilitation trials (&lt;30 days post-stroke) presents unique challenges compared to conventional stroke trials recruiting individuals &gt;6 months post-stroke. Preclinical studies suggest treatments be initiated sooner after stroke, thus requiring stroke rehabilitation trials be conducted within days post-stroke. How do specific inclusion and exclusion criteria affect trial recruitment rates for early stroke rehabilitation trials?Objectives: Provide estimates of trial recruitment based on screening and enrollment data from a phase II early stroke rehabilitation trial.Methods: CPASS, a phase II intervention trial screened ischemic stroke patients in acute care (18-months, N = 395) and inpatient rehabilitation (22-months, N = 673). Patients were stratified by upper extremity (UE) impairment into mild (NIHSS motor arm = 0, 1); moderate (NIHSS = 2, 3); severe (NIHSS = 4) and numbers of patients disqualified due to CPASS exclusion criteria determined. We also examined if a motor-specific evaluation (Action Research Arm Test, ARAT) increases the pool of eligible patients disqualified by the NIHSS motor arm item.Results: CPASS recruitment in acute care (5.3%) and inpatient rehabilitation (5%) was comparable to prior trials. In acute care, a short stay (7–17-days), prior stroke (13.5% in moderately; 13.2% in severely impaired) disqualified the majority. In inpatient rehabilitation, the majority (40.8%) were excluded for “too mild” impairment. The next majority were disqualified for reaching inpatient rehabilitation “too late” to participate in an early stroke trial (15% in moderately; 24% in severely impaired). Mean ARAT in the “too mild” showed significant impairment and potential to benefit from participation in select UE rehabilitation trials.Conclusions: Screening of ischemic stroke patients while they are still in acute care is crucial to successful recruitment for early stroke rehabilitation trials. A significant proportion of eligible patients are lost to “short length of stay” in acute care, and arrive to inpatient rehabilitation “too late” for an early rehabilitation trial. Additional screening of mildly impaired patients using a motor function specific scale will benefit the trial recruitment and generalizability.Trial Registration Number:http://www.clinicaltrials.gov Identifier: NCT02235974.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 437-445
Author(s):  
Irene Ciancarelli ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Stefano Paolucci ◽  
Loris Pignolo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Patients ◽  
Rehabilitation Outcomes ◽  
Before And After ◽  
Forward Stepwise ◽  
Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

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