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Bright L, Baum CM, Roberts P. Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:455-466. [PMID: 38654705 DOI: 10.1177/15394492241246546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.
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Affiliation(s)
- Lindsay Bright
- Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Washington University School of Medicine, St. Louis, MO, USA
- Washington University in St. Louis, MO, USA
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Bright L, Baum CM, Roberts P. Racial disparities among mild stroke survivors: predictors of home discharge from a retrospective analysis. Top Stroke Rehabil 2024:1-7. [PMID: 38516991 DOI: 10.1080/10749357.2024.2329491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Half of all strokes are classified as mild, and most mild stroke survivors are discharged home after their initial hospitalization without any post-acute rehabilitation despite experiencing cognitive, psychosocial, motor, and mobility impairments. OBJECTIVES To investigate the demographic and clinical characteristics of mild stroke survivors and their association with discharge location. METHODS This is a retrospective analysis of mild stroke survivors from 2015-2023 in an academic medical center. Demographic characteristics, clinical measures, and discharge locations were obtained from the electronic health record. The Social Vulnerability Index was used to measure the community vulnerability. Associations between variables and discharge location were examined using bivariate logistic regression analysis. RESULTS There were 2,953 mild stroke survivors included in this study. The majority of participants were White (65.46%), followed by Black (19.40%). Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p = 0.001). Black patients and patients with high vulnerability in housing type and transportation were less likely to be discharged home. CONCLUSIONS Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts, emphasizing the importance of addressing these disparities for equitable healthcare delivery and optimal outcomes.
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Affiliation(s)
- Lindsay Bright
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Pamela Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
- Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, CA, USA
- Department of Medical Affairs, Cedars-Sinai, Los Angeles, CA, USA
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Schrader M, Sterr A, Strank T, Bamborschke S, Dohle C. Effects of transsectoral long-term neurorehabilitation. Neurol Res Pract 2024; 6:7. [PMID: 38326907 PMCID: PMC10851455 DOI: 10.1186/s42466-023-00302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Acquired brain injuries are among the most common causes of disability in adulthood. An intensive rehabilitation phase is crucial for recovery. However, there is a lack of concepts to further expand the therapeutic success after the standard rehabilitation period. Hereafter, the characteristics of a transsectoral, multiprofessional long-term neurorehabilitation concept and its effects on outcome at different ICF levels are described. METHODS The P.A.N. Center for Post-Acute Neurorehabilitation combines living with 24/7 support of pedagogical staff with on-site outpatient therapy and medical care. A secondary data analysis was conducted on the records of all patients with completeted P.A.N. treatment between 01.01.2015 and 09.04.2022. Outcome parameters included demographic characteristics, diagnostics, Barthel Index (BI), the German scale "Hilfebedarf von Menschen mit Behinderung für den Lebensbereich Wohnen " (HMBW), the Canadian Occupational Performance Measure (COPM) and the destination after discharge. For BI and discharge destination, potential determinants of therapy success are evaluated. RESULTS 168 patients were enrolled in the analyses. Significant improvements were observed in the BI (p < .001), with median values increasing from 55 to 80 points. The HMBW showed a significant decrease in the need for assistance in everyday living (p < .001), individual basic care (p < .001), shaping social relationship (p = .003) and communication (p < .001). Significant improvements were reported in the COPM total score for performance (p < .001) and satisfaction (p < .001). 72% of the patients were able to move in a community living arrangement with moderate need for support. Main predictive factor for discharge destination was the initial cognitive deficit. The comparison of the third-person scales BI and HMBW with the self-reported COPM showed that individually formulated patient goals are only insufficiently reflected in these global scales. DISCUSSION The data show that a highly coordinated, trans-sectoral 24/7 approach of goal-oriented practice as pursued at P.A.N. is feasible and effective. We assume that the success of the intervention is due to the high intensity of therapies delivered over a long time and its interlink with real world practice. For a comprehensive analysis of rehabilitation success, it is necessary to record and evaluate individual patient goals, as these are not always reflected in the commonly used global scales.
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Affiliation(s)
- Mareike Schrader
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Wildkanzelweg 28, 13465, Berlin, Germany.
| | - Annette Sterr
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Wildkanzelweg 28, 13465, Berlin, Germany
- School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
| | - Tobias Strank
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Wildkanzelweg 28, 13465, Berlin, Germany
| | - Stephan Bamborschke
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Wildkanzelweg 28, 13465, Berlin, Germany
| | - Christian Dohle
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Wildkanzelweg 28, 13465, Berlin, Germany
- Center for Stroke Research Berlin, Charité - University Medicine Berlin, 10117, Berlin, Germany
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McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Iwasa S, Uchiyama Y, Tauchi Y, Koyama T, Domen K. Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan. J Rural Med 2024; 19:33-39. [PMID: 38196805 PMCID: PMC10774001 DOI: 10.2185/jrm.2023-033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. Patients and Methods: We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. Results: The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. Conclusion: This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.
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Affiliation(s)
- Saya Iwasa
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
| | - Yuta Tauchi
- Department of Rehabilitation Medicine, Sasayama Medical Center, Hyogo Medical University, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Japan
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Herbold J, Elmohsen E, Gutierrez G, Helgesen M, Babyar S. Prediction of Discharge Destination After Inpatient Rehabilitation for Stroke Using Mobility and Self-Care Assessment in Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Instrument. Arch Rehabil Res Clin Transl 2023; 5:100292. [PMID: 38163021 PMCID: PMC10757179 DOI: 10.1016/j.arrct.2023.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To determine the ability of Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Inventory (Section GG)'s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation. Design Retrospective, observational cohort study. Setting 150-bed inpatient rehabilitation facility within a metropolitan health system. Participants Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19. Intervention None. Main Outcome Measures Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons. Results Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (P<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility. Conclusion Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.
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Affiliation(s)
- Janet Herbold
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
| | - Ebrahim Elmohsen
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Gino Gutierrez
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Michael Helgesen
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Suzanne Babyar
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
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Chevalley O, Truijen S, Opsommer E, Saeys W. Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis. Clin Rehabil 2023; 37:1698-1716. [PMID: 37424501 PMCID: PMC10580673 DOI: 10.1177/02692155231185446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. DATA SOURCES A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023. METHODS Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data. RESULTS Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination. CONCLUSION This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.
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Affiliation(s)
- Odile Chevalley
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Tarvonen-Schröder S, Koivisto M. Predicting institutionalization after Subacute Stroke Rehabilitation using the 12-Item World Health Organization Disability Assessment Schedule. J Rehabil Med 2023; 55:jrm6531. [PMID: 37548437 PMCID: PMC10424248 DOI: 10.2340/jrm.v55.6531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/31/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE To evaluate the utility of the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after subacute stroke rehabilitation. DESIGN Prospective observational study. METHODS On a specialized rehabilitation ward, discharge WHODAS-12 scores of 156 consecutive patients (24-h National Institutes of Health Stroke Scale (NIHSS) ≥ 15) and assessment from their proxies were compared, and receiver operating characteristic curves for predicting institutionalization were generated. Clinician-rated assessments of functioning were applied for comparison. RESULTS Thirty-three percent of the patients were unfit to respond, due to the consequences of major stroke. However, both patient and proxy WHODAS-12 sum scores differentiated the community (n = 70) and institution (n = 86) groups (p = 0.02 and p < 0.0001, respectively), the discriminative accuracy (area under the curve; AUC) being 0.63 and 0.79, respectively. In proxy assessments, the institutionalized patients were significantly more impaired in all item comparisons except for emotions and concentrating. Ability to participate differentiated the groups as accurately as activities (AUC 0.75 vs 0.78, respectively). The corresponding discriminative accuracy of the clinician-rated World Health Organization (WHO) minimal generic dataset sum score and modified Rankin Scale were 0.74 and 0.79 (p < 0.0001), respectively. CONCLUSION Despite its brevity and subjectivity, the WHODAS-12 from proxies has shown high accuracy in predicting institutionalization after subacute rehabilitation of individuals with major stroke, the impact of participation being as relevant as that of activities.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland and Clinical Neurosciences, University of Turku, Turku, Finland.
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
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Fisher RJ, Russell L, Riley-Bennett F, Cameron T, Walker M, Sackley C. Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams. BMJ Open 2023; 13:e071217. [PMID: 37532479 PMCID: PMC10401239 DOI: 10.1136/bmjopen-2022-071217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them. DESIGN Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis. SETTING Online, MSTeams, UK. PARTICIPANTS A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7). RESULTS High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors. CONCLUSIONS Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed.
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Affiliation(s)
| | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Muto K, Shiratsuchi D, Nanbu K, Sakamoto H, Furuya N, Nakamura K, Yushi M, Tsujita N, Makizako H. Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination. J Stroke Cerebrovasc Dis 2023; 32:107145. [PMID: 37210777 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. MATERIALS AND METHODS This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. RESULTS Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). CONCLUSIONS The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.
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Affiliation(s)
- Kento Muto
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan.
| | - Daijo Shiratsuchi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuki Nanbu
- Nishino hospital, 13-27 Sanjimatsuomachi, Yahatahigasiku, Kitakyusyushi, Fukuoka 805-0033, Japan
| | - Hayato Sakamoto
- Division of Rehabilitation Services, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Naohiro Furuya
- Department of Rehabilitation, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayamashi, Saitama, 350-1305, Japan
| | - Kazushi Nakamura
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Mitani Yushi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Nako Tsujita
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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Fujita T, Yamane K, Yamamoto Y, Sone T, Ohira Y, Otsuki K, Iokawa K. Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward. Medicine (Baltimore) 2023; 102:e34152. [PMID: 37352048 PMCID: PMC10289490 DOI: 10.1097/md.0000000000034152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/06/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.
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Affiliation(s)
- Takaaki Fujita
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Kazuhiro Yamane
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Toshimasa Sone
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Yoko Ohira
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Kita-Fukushima Medical Center, Date, Fukushima, Japan
| | - Kazuaki Iokawa
- Department of Occupational Therapy, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
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Pattath P, Odom EC, Tong X, Yin X, Coleman King SM. A Comparison of Acute Ischemic Stroke Patients Discharged to Inpatient Rehabilitation vs a Skilled Nursing Facility: The Paul Coverdell National Acute Stroke Program. Arch Phys Med Rehabil 2023; 104:605-611. [PMID: 36521579 PMCID: PMC11015737 DOI: 10.1016/j.apmr.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/07/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the sociodemographic, clinical, and hospital related factors associated with discharge of acute ischemic stroke (AIS) survivors to inpatient rehabilitation (IRF) and skilled nursing facility (SNF) rehabilitation services. DESIGN Retrospective descriptive study from the Paul Coverdell National Acute Stroke Program (PCNASP) participating hospitals during 2016 to 2019. SETTING 9 Participating states from PCNASP in United States. PARTICIPANTS 130,988 patients with AIS from 569 hospitals (N=337,857). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Discharge to IRF and SNF. RESULTS Patients discharged to a SNF had longer length of hospital stay, more comorbidities, and higher modified Rankin scores compared with patients discharged to an IRF. Nine characteristics were associated with being less likely to be discharged to an IRF than an SNF: older age (85+ years old, adjusted odds ratio [AOR]=0.20 [confidence interval [CI]=0.18-0.21]), identifying as non-Hispanic Black (AOR=0.85 [CI=0.81-0.89]), identifying as Hispanic (AOR=0.80 [CI=0.74-0.87]), having Medicaid or Medicare (AOR=0.73 [CI=0.70-0.77]), being able to ambulate with assistance from another person (AOR=0.93 [CI=0.89-0.97]), being unable to ambulate (AOR=0.73 [CI=0.62-0.87]) and having comorbidities, prior stroke (AOR=0.69 [CI=0.66-0.73]), diabetes (AOR=0.85 [CI=0.82-0.88]), and myocardial infraction or coronary artery disease (AOR=0.94 [CI=0.90-0.97]). Four characteristics were associated with being more likely to be discharged to an IRF than an SNF: being a man (AOR=1.20 [CI=1.16-1.24]), and having a slight disability (Rankin Score 2) (AOR=1.41 [CI=1.29-1.54]), being at larger hospitals (200-399 beds: AOR=1.31 [CI=1.23-1.40]; 400+ beds: AOR=1.29 [CI=1.20-1.38]), and being at a hospital with stroke unit (AOR=1.12 [CI=1.07-1.17]). CONCLUSION This study found differences in demographic, clinical, and hospital characteristics of AIS patients discharged for rehabilitation to an IRF vs SNF. The characteristics of patients receiving rehabilitation services may be helpful for researchers and hospitals making policies related to stroke discharge and practices that optimize patient outcomes. Populations experiencing inequities in access to rehabilitation services should be identified, and those who qualify for rehabilitation in IRF should receive this care in preference to rehabilitation in SNF.
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Affiliation(s)
- Priyadarshini Pattath
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Erika C Odom
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States; United States Public Health Service, Atlanta, GA, United States.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xiaoping Yin
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sallyann M Coleman King
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States; United States Public Health Service, Atlanta, GA, United States
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13
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Rohmann JL, Huerta-Gutierrez R, Audebert HJ, Kurth T, Piccininni M. Adjusted horizontal stacked bar graphs (“Grotta bars”) for consistent presentation of observational stroke study results. Eur Stroke J 2023; 8:370-379. [PMID: 37021164 PMCID: PMC10069225 DOI: 10.1177/23969873221149464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Modified Rankin Scale (mRS) scores are used to measure functional outcomes after stroke. Researchers create horizontal stacked bar graphs (nicknamed “Grotta bars”) to illustrate distributional differences in scores between groups. In well-conducted randomized controlled trials, Grotta bars have a causal interpretation. However, the common practice of exclusively presenting unadjusted Grotta bars in observational studies can be misleading in the presence of confounding. We demonstrated this problem and a possible solution using an empirical comparison of 3-month mRS scores among stroke/TIA patients discharged home versus elsewhere after hospitalization. Patients and methods: Using data from the Berlin-based B-SPATIAL registry, we estimated the probability of being discharged home conditional on prespecified measured confounding factors and generated stabilized inverse probability of treatment (IPT) weights for each patient. We visualized mRS distributions by group with Grotta bars for the IPT-weighted population in which measured confounding was removed. We then used ordinal logistic regression to quantify unadjusted and adjusted associations between being discharged home and the 3-month mRS score. Results: Of 3184 eligible patients, 2537 (79.7%) were discharged home. In the unadjusted analyses, those discharged home had considerably lower mRS compared with patients discharged elsewhere (common odds ratio, cOR = 0.13, 95% CI: 0.11–0.15). After removing measured confounding, we obtained substantially different mRS distributions, visually apparent in the adjusted Grotta bars. No statistically significant association was found after confounding adjustment (cOR = 0.82, 95% CI: 0.60–1.12). Discussion and conclusion: The practice of presenting only unadjusted stacked bar graphs for mRS scores together with adjusted effect estimates in observational studies can be misleading. IPT weighting can be implemented to create Grotta bars that account for measured confounding, which are more consistent with the presentation of adjusted results in observational studies.
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Affiliation(s)
- Jessica L Rohmann
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Rodrigo Huerta-Gutierrez
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
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14
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Benković V, Parker M, Novaković T, Meštrović A, Budinčević H. The cost of ischaemic stroke in Croatia. Eur Stroke J 2023; 8:21-27. [PMID: 36793741 PMCID: PMC9923131 DOI: 10.1177/23969873221123840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 02/12/2023] Open
Abstract
Objective The aim of this analysis was to estimate 1 year and long-term cost and quality of life of ischaemic stroke patients in Croatia. In addition, we aimed to identify and estimate key categories of costs and outcomes driving the burden of stroke in Croatian healthcare system. Methods Data were derived from analysis of the RES-Q Registry for Croatia in 2018 and supplemented with clinical expert opinion and relevant medical, clinical and economic literature to estimate the course of the disease and treatment patterns in Croatian healthcare system. The health economic model was comprised of a one-year discrete event simulation (DES) mapping real life patient experience and a 10-year Markov model built on existing literature. Cost and health resources use were obtained using Croatian tariffs. Health utilities were mapped to EQ5D from the Barthel Index utilising previously published studies. Results The key aspects determining costs and quality of life were rehabilitation, discharge to residential care (currently 13% of patients in Croatia) and recurrent stroke. Total 1 year cost per patient was 18,221 EUR having 0.372 QALYs. Conclusion Direct costing structure of ischaemic stroke in Croatia is above the value of upper-middle income countries. Our study showed that post stroke rehabilitation seems to be a strong modifier of future post-stroke costs and further research into various models of post-stroke care and rehabilitation could be the answer into more successful rehabilitation that could increase QALY and reduce the economic burden of stroke. Further investment in rehabilitation research and provision might bring promising opportunities to improve long term patient outcomes.
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Affiliation(s)
- Vanesa Benković
- Croatian Society for Pharmacoeconomics
and Health Economics, Zagreb, Croatia
| | | | | | - Andrija Meštrović
- Stroke and Intensive Care Unit,
Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Hrvoje Budinčević
- Stroke and Intensive Care Unit,
Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia,Faculty of Medicine, Department of
Neurology and Neurosurgery, J.J. Strossmayer University of Osijek, Osijek,
Croatia,Hrvoje Budinčević, Stroke and Intensive
Care Unit, Department of Neurology, Sveti Duh University Hospital, Sveti Duh 64,
Zagreb, 10000, Croatia.
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15
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Tarvonen-Schröder S, Niemi T, Koivisto M. Inpatient Rehabilitation After Acute Severe Stroke: Predictive Value of the National Institutes of Health Stroke Scale Among Other Potential Predictors for Discharge Destination. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:27536351231157966. [PMID: 37223636 PMCID: PMC10201155 DOI: 10.1177/27536351231157966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/25/2023] [Indexed: 05/25/2023]
Abstract
Background Research focusing on predictors for discharge destination after rehabilitation of inpatients recovering from severe stroke is scarce. The predictive value of rehabilitation admission NIHSS score among other potential predictors available on admission to rehabilitation has not been studied. Aim The aim of this retrospective interventional study was to determine the predictive accuracy of 24 hours and rehabilitation admission NIHSS scores among other potential socio-demographic, clinical and functional predictors for discharge destination routinely collected on admission to rehabilitation. Material and Methods On a university hospital specialized inpatient rehabilitation ward 156 consecutive rehabilitants with 24 hours NIHSS score ⩾15 were recruited. On admission to rehabilitation, routinely collected variables potentially associated with discharge destination (community vs institution) were analyzed using logistic regression. Results 70 (44.9%) of rehabilitants were discharged to community, and 86 (55.1%) were discharged to institutional care. Those discharged home were younger and more often still working, had less often dysphagia/tube feeding or DNR decision in the acute phase, shorter time from stroke onset to rehabilitation admission, less severe impairment (NIHSS score, paresis, neglect) and disability (FIM score, ambulatory ability) on admission, and faster and more significant functional improvement during the in-stay than those institutionalized. Conclusion The most influential independent predictors for community discharge on admission to rehabilitation were lower admission NIHSS score, ambulatory ability and younger age, NIHSS being the most powerful. The odds of being discharged to community decreased with 16.1% for every 1 point increase in NIHSS. The 3-factor model explained 65.7% of community discharge and 81.9% of institutional discharge, the overall predictive accuracy being 74.7%. The corresponding figures for admission NIHSS alone were 58.6%, 70.9% and 65.4%.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
| | - Tuuli Niemi
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Expert Services, Turku
University Hospital, Turku, Finland
| | - Mari Koivisto
- Neurocenter, Turku University Hospital,
Turku, Finland
- Department of Clinical Neurosciences,
University of Turku, Turku, Finland
- Department of Biostatistics, University
of Turku, Turku, Finland
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16
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Pierre K, Perez-Vega C, Fusco A, Olowofela B, Hatem R, Elyazeed M, Azab M, Lucke-Wold B. Updates in mechanical thrombectomy. EXPLORATION OF NEUROSCIENCE 2022; 1:83-99. [PMID: 36655054 PMCID: PMC9845048 DOI: 10.37349/en.2022.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 01/01/2023]
Abstract
Stroke is a leading cause of morbidity and mortality. The advent of mechanical thrombectomy has largely improved patient outcomes. This article reviews the features and outcomes associated with aspiration, stent retrievers, and combination catheters used in current practice. There is also a discussion on clinical considerations based on anatomical features and clot composition. The reperfusion grading scale and outcome metrics commonly used following thrombectomy when a patient is still in the hospital are reviewed. Lastly, there are proposed discharge and outpatient follow-up goals in caring for patients hospitalized for a stroke.
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Affiliation(s)
- Kevin Pierre
- Department of Radiology, University of Florida, Gainesville, FL 32608, USA
| | - Carlos Perez-Vega
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Fusco
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Bankole Olowofela
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Rami Hatem
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mohammed Elyazeed
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Mohammed Azab
- Biomolecular Sciences Graduate Program, Boise State University, Boise, ID 83725, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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17
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Hayes HA, Marcus R, Stoddard GJ, McFadden M, Magel J, Hess R. Is the Activity Measure for Postacute Care "6-Clicks" Tool Associated With Discharge Destination Postacute Stroke? Arch Rehabil Res Clin Transl 2022; 4:100228. [PMID: 36545521 PMCID: PMC9761263 DOI: 10.1016/j.arrct.2022.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the association of poststroke physical function, measured within 24 hours prior to discharge from the acute care hospital using Activity Measure for Postacute Care (AM-PAC) Inpatient "6-Clicks" scores and discharge destination (home vs facility and inpatient rehabilitation facility [IRF] vs skilled nursing facility [SNF]). Design Retrospective cross-sectional cohort study. Setting Acute care, University Hospital. Participants Individuals post acute ischemic stroke, N=721, 51.3% male, mean age 63.6±16.4 years. Interventions Not applicable. Main Outcome Measures AM-PAC "6-Clicks" 3 domains: basic mobility, daily activity, and applied cognition. Results AM-PAC basic mobility and daily activity were significant predictors of discharge. Those in the home discharge group had AM-PAC basic mobility mean t scale score of 48.5 compared with a score of 34.8 for individuals sent to a facility and daily activity score of 47.2 compared with 32.7 for individuals sent to a facility. The AM-PAC variables accounted for an additional 24% of the variance in the discharge destination, with basic mobility and daily activity accounting for most of the variance.The AM-PAC scores were not statistically different and were not able to discriminate between placement in an IRF vs SNF. The mean basic mobility t scale score for individuals going to an IRF was 34.9 compared with 34.6 for those going to an SNF. The daily activity score for IRF was 32.8 compared with 32.6 for SNF. The AM-PAC accounted for no additional variance in discharge destination to an IRF or SNF. Conclusions The AM-PAC Inpatient "6-Clicks" 3 domains are able to distinguish individuals with stroke being discharged to home from postacute care (PAC) but not for differentiating between PAC facilities (IRF vs SNF) in this cohort of individuals post stroke.
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Affiliation(s)
- Heather Anne Hayes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Robin Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | | | - Molly McFadden
- Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Jake Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Rachel Hess
- Division of Health System Innovation and Research, University of Utah, Salt Lake City, UT
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18
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Veerbeek JM, Ottiger B, Cazzoli D, Vanbellingen T, Nyffeler T. Speed up discharge planning at the acute stroke unit: A development and external validation study for the early prediction of discharge home. Front Neurol 2022; 13:999595. [PMID: 36188378 PMCID: PMC9523004 DOI: 10.3389/fneur.2022.999595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background To reduce healthcare costs, it has become increasingly important to shorten the length of stay in acute stroke units. The goal of this study was to develop and externally validate a decision tree model applicable < 48 h poststroke for discharge home from an acute stroke unit with a short length of stay, and to assess the inappropriate home discharge rate. Methods A prospective study including two samples of stroke patients admitted to an acute stroke unit. The outcome was discharge home (yes/no). A classification and regression tree analysis was performed in Sample 1. The model's performance was tested in Sample 2. Results In total, 953 patients were included. The final decision tree included the patients' activities of daily living (ADL) performance <48 h poststroke, including motor function, cognition, and communication, and had an area under the curve (AUC) of 0.84 (95% confidence interval 0.76, 0.91). External validation resulted in an AUC of 0.74 (95% confidence interval 0.72, 0.77). None of the patients discharged home were re-admitted < 2 months after discharge to a hospital or admitted to a rehabilitation center for symptoms that had needed inpatient neurorehabilitation. Conclusions The developed decision tree shows acceptable external validity in predicting discharge home in a heterogeneous sample of stroke patients, only based on the patient's actual ADL performance <48 h poststroke. Importantly, discharge was safe, i.e., no re-hospitalization was registered. The tree's application to speed up discharge planning should now be further evaluated.
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Affiliation(s)
- Janne Marieke Veerbeek
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- *Correspondence: Janne Marieke Veerbeek
| | | | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Koumo M, Goda A, Maki Y, Yokoyama K, Yamamoto T, Hosokawa T, Ishibashi R, Katsura J, Yanagibashi K. Clinical Items for Geriatric Patients with Post-Stroke at Discharge or Transfer after Rehabilitation Therapy in a Chronic-Phase Hospital: A Retrospective Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081577. [PMID: 36011234 PMCID: PMC9408440 DOI: 10.3390/healthcare10081577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Clinical factors related to destination after rehabilitation therapy for geriatric patients with post-stroke in chronic-phase hospitals have not been elucidated. This study analyzed the clinical characteristics of geriatric patients with post-stroke at discharge/transfer after rehabilitation therapy in a chronic-phase hospital. Fifty-three patients (20 men, 33 women; mean age 81.36 ± 8.14 years) were recruited (the period analyzed: October 2013−March 2020). Clinical data were statistically analyzed among patients discharged to homes or facilities for older adults or transferred to another hospital. In addition, we analyzed the clinical items at discharge and transfer after rehabilitation therapy using a decision tree analysis. Twelve patients were discharged, eighteen were discharged to facilities for older adults, and twenty-three were transferred to another hospital. There were significant differences in the modified Rankin Scale, admission dates, functional independence measure (FIM) score, and Barthel Index score in the three groups (p < 0.05). Patients with motor subtotal functional independence scores of ≥14 (chronologically improved ≥5) after rehabilitation therapy for <291 days were more likely to be discharged home. Patients in a chronic-phase hospital who improved within a limited period were discharged to their homes, whereas those who were bedridden tended to be transferred to another hospital.
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Affiliation(s)
- Masatoshi Koumo
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan
- Correspondence: ; Tel.: +81-(0)75-574-4313
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone 522-0054, Japan
| | - Kouta Yokoyama
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Tetsuya Yamamoto
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Tsumugi Hosokawa
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka 530-0025, Japan
| | - Junichi Katsura
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
| | - Ken Yanagibashi
- Department of Rehabilitation, Hikari Hospital, Otsu 520-0002, Japan
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20
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Clarification of Factors Determining Discharge Destination Among Elderly Patients After Stroke With Low Levels of Independence in Activities of Daily Living: A Retrospective Study. Arch Rehabil Res Clin Transl 2022; 4:100226. [PMID: 36545528 PMCID: PMC9761264 DOI: 10.1016/j.arrct.2022.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To determine factors influencing discharge destination of elderly patients after stroke with low levels of independence in activities of daily living (ADL). Design Cross-sectional study. Setting A community-based public hospital in a rural area in Japan. Participants A total of 67 patients with low daily function among 205 elderly patients with stroke screened for eligibility (N=67). Interventions Not applicable. Main Outcome Measures Motor component of functional independence measure (M-FIM) at discharge and discharge destination-home or long-term care facility (LCF). Results Among the 205 eligible patients, 147 were discharged home and 58 were discharged to LCFs. Patients with an M-FIM score of ≤30 at discharge were defined as patients deemed difficult to discharge home because of low independence levels in ADL. Of the 147 patients discharged home, 24 (16.3%) had M-FIM scores of ≤30. Of the 58 patients discharged to LCFs, 43 (74.1%) had M-FIM scores of ≤30. Patients with an M-FIM score of ≤30 at discharge significantly tended to be discharged home if they obtained oral intake vs tube feeding as a nutritional method (P=.047) and higher cognitive component of FIM scores at discharge (P=.002). All six patients who lived alone among patients with an M-FIM score of ≤30 were discharged to LCFs. Two patients on tube feeding were discharged home. Conclusions Nutritional method, cognitive function at discharge, and the prestroke living situation with or without household caregivers are important factors of discharge among elderly patients after stroke with low independence levels in ADL. However, only a small number of severely disabled patients were successfully discharged home.
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21
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Prick JCM, van Schaik SM, Deijle IA, Dahmen R, Brouwers PJAM, Hilkens PHE, Garvelink MM, Engels N, Ankersmid JW, Keus SHJ, The R, Takahashi A, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM, van Schaik S, Brouwers P, Hilkens P, van Dijk G, Gons R, Saxena R, Schut E. Development of a patient decision aid for discharge planning of hospitalized patients with stroke. BMC Neurol 2022; 22:245. [PMID: 35790912 PMCID: PMC9254531 DOI: 10.1186/s12883-022-02679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/11/2022] [Indexed: 10/13/2023] Open
Abstract
Abstract
Background
Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke.
Methods
A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria.
Results
In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of:
1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient;
2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated “patients-like-me” model with outcome information about discharge destinations;
3) a summary sheet to support actual decision-making during consultation, containing the patient’s values and preferences concerning discharge planning.
In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information.
Conclusions
The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness.
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22
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Casertano LO, Bassile CC, Pfeffer JS, Morrone TM, Stein J, Willey JZ, Rao AK. Utility of the AM-PAC "6 Clicks" Basic Mobility and Daily Activity Short Forms to Determine Discharge Destination in an Acute Stroke Population. Am J Occup Ther 2022; 76:23318. [PMID: 35771733 DOI: 10.5014/ajot.2022.047381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The American Heart Association and American Stroke Association recommend early identification of level of rehabilitative care as a priority after stroke. OBJECTIVE To evaluate the utility of the Activity Measure for Post-Acute Care (AM-PAC) "6 Clicks" Daily Activity and Basic Mobility forms to determine the next level of rehabilitation after hospitalization for adults with stroke. DESIGN Retrospective cohort design using medical records from 2015 to 2016. SETTING Major urban hospital. PARTICIPANTS Patients admitted to the stroke service, with a confirmed stroke, who were seen by a physical or occupational therapist; who had a 6 Clicks Basic Mobility or Daily Activity score at initial evaluation; and who were discharged to home, an acute inpatient rehabilitation facility (IRF), or a subacute skilled nursing facility (SNF). OUTCOMES AND MEASURES Length of stay and discharge destination. RESULTS Seven hundred four participants (M age = 68.28 yr; 51.21% female) were included. Analysis of variance and receiver operating characteristic curves were performed. Daily Activity scores were highest for home discharge, lower for IRF discharge, and lowest for SNF discharge; Basic Mobility showed a similar pattern. Cutoff values distinguishing home from further inpatient rehabilitation were 44.50 for Basic Mobility and 39.40 for Daily Activity scores (area under the curve [AUC] = .82 for both forms), with scores of 34.59 (AUC = 0.64) and 31.32 (AUC = 0.67) separating IRF from SNF, respectively. CONCLUSIONS AND RELEVANCE Therapists should incorporate 6 Clicks scores into their discharge planning. What This Article Adds: This research demonstrates the utility of an outcome measure in the acute care setting that assists in planning discharge destination for patients with stroke.
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Affiliation(s)
- Lorenzo O Casertano
- Lorenzo O. Casertano, PT, DPT, NCS, is Advanced Clinician-Acute Care Neurology, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY;
| | - Clare C Bassile
- Clare C. Bassile, PT, EdD, is Associate Professor, Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY
| | - Jacqueline S Pfeffer
- Jacqueline S. Pfeffer, PT, MPH, is Compliance Coordinator, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY
| | - Theresa M Morrone
- Theresa M. Morrone, PT, MS, CCS, passed away during the process of resubmission. At the time of the study, Morrone was Director, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY
| | - Joel Stein
- Joel Stein, MD, is Professor and Chair, Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, and Chief, Department of Rehabilitation Medicine, New York-Presbyterian Hospital, New York, NY
| | - Joshua Z Willey
- Joshua Z. Willey, MD, MS, is Assistant Attending and Associate Professor of Neurology, Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ashwini K Rao
- Ashwini K. Rao, OTR, EdD, FAOTA, is Professor, Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY
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23
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Waller CP, Sangelaji B, Hargest C, Woodley SJ, Lamb P, Kuys S, Calder A, Hale LA. Biomechanics of the paretic knee during overground gait in people with stroke: a systematic review. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2090088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Clifford Paul Waller
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Bahram Sangelaji
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Claire Hargest
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Peter Lamb
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Suzanne Kuys
- School of Allied Health (Faculty of Health Sciences), Australian Catholic University, Brisbane, Australia
| | - Allyson Calder
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh A. Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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24
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Ecker S, Lord A, Gurin L, Olivera A, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Psychological Outcome after Hemorrhagic Stroke is Related to Functional Status. J Stroke Cerebrovasc Dis 2022; 31:106492. [PMID: 35594604 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To identify opportunities to improve morbidity after hemorrhagic stroke, it is imperative to understand factors that are related to psychological outcome. DESIGN/METHODS We prospectively identified patients with non-traumatic hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) between January 2015 and February 2021 who were alive 3-months after discharge and telephonically assessed 1) psychological outcome using the Quality of Life in Neurological Disorders anxiety, depression, emotional and behavioral dyscontrol, fatigue and sleep disturbance inventories and 2) functional outcome using the modified Rankin Scale (mRS) and Barthel Index. We also identified discharge destination for all patients. We then evaluated the relationship between abnormal psychological outcomes (T-score >50) and discharge destination other than home, poor 3-month mRS score defined as 3-5 and poor 3-month Barthel Index defined as <100. RESULTS 73 patients were included; 41 (56%) had an abnormal psychological outcome on at least one inventory. There were 41 (56%) patients discharged to a destination other than home, 44 (63%) with poor mRS score and 28 (39%) with poor Barthel Index. Anxiety, depression, emotional and behavioral dyscontrol and sleep disturbance were all associated with a destination other than home, poor mRS score, and poor Barthel Index (all p<0.05). Fatigue was related to poor mRS score and poor Barthel Index (p=0.005 and p=0.006, respectively). CONCLUSION Multiple psychological outcomes 3-months after hemorrhagic stroke are related to functional status. Interventions to improve psychological outcome and reduce morbidity in patients with poor functional status should be explored by the interdisciplinary team.
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Affiliation(s)
- Sarah Ecker
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Aaron Lord
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Lindsey Gurin
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Psychiatry, NY 10016, New York; NYU Langone Medical Center, Department of Rehabilitation Medicine, NY 10016, New York
| | - Anlys Olivera
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Psychiatry, NY 10016, New York
| | - Koto Ishida
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Kara Melmed
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Jose Torres
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Cen Zhang
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York
| | - Jennifer Frontera
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York
| | - Ariane Lewis
- NYU Langone Medical Center, Department of Neurology, NY 10016, New York; NYU Langone Medical Center, Department of Neurosurgery, NY 10016, New York.
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25
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Moving Back into the Community: Obstacles for People With an Acquired Brain Injury or Physical Disability. J Am Med Dir Assoc 2022; 23:1396-1402. [PMID: 35219605 DOI: 10.1016/j.jamda.2022.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/09/2021] [Accepted: 01/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate transitions from long-term institutional care to the community in people with an acquired brain injury (ABI) or a physical disability (PD). Secondary objectives were to identify barriers in each group. DESIGN Retrospective observational study based on a person-centered plan and structured interviews to identify potential barriers. SETTING AND PARTICIPANTS Long-term institutional care; 2954 Medicaid participants younger than 65 interested in community living. METHODS Analysis with SPSS 25 of 445 people with an ABI and 2509 with a PD living in long-term care between December 2008 and November 2017. The main outcome was transition to the community. Secondary measures identified specific barriers such as consumer engagement, gender, and age. RESULTS Of the 2954 total cases, 1810 (61.3%) transitioned to the community; 57.5% of the ABI group (n = 256) and 61.9% of the PD group (n = 1554) transitioned. Although the PD group transitioned at a slightly higher rate, no significant association was found between the program (ABI or PD) and the likelihood of transitioning (χ2 [df = 1] = 3.096, P = .078). Overall, in the ABI group, difficulties with the funding program, OR = 0.373 ± 0.238, and other individuals, OR = 0.396 ± 0.344, decreased the odds of transitioning more than other challenges, whereas lack of consumer engagement, OR = 0.659 ± 0.100, had the strongest influence on preventing transitions in the PD group. CONCLUSIONS AND IMPLICATIONS Living in the community improves quality of life and decreases costs. No previous studies have focused on the major obstacles for 2 specific groups, those with an ABI and those with a PD. Identifying transition rates and specific barriers for different groups is an important step to developing systems that will overcome these obstacles. In addition, the equivalent transition rates between these groups highlights the benefit of increased funding and range of services for those with complex needs and support requirements.
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26
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Ikezawa K, Hirose M, Maruyama T, Yuji K, Yabe Y, Kanamori T, Kaide N, Tsuchiya Y, Hara S, Suzuki H. Effect of early nutritional initiation on post-cerebral infarction discharge destination: A propensity-matched analysis using machine learning. Nutr Diet 2021; 79:247-254. [PMID: 34927343 DOI: 10.1111/1747-0080.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
AIM Malnutrition is associated with poor outcomes in cerebral infarction patients, with research indicating that early nutritional initiation may improve the short-term prognosis of patients. However, evidence supported by big data is lacking. Here, to determine the effect of nutritional initiation during the first 3 days after hospital admission on home discharge rates, propensity score matching was conducted in patients with acute cerebral infarction. METHODS This retrospective observational study, using the Diagnosis Procedure Combination anonymised database in Japan, included 41 477 ischaemic cerebral infarction patients hospitalised between 2016 and 2019. The patients were divided into two groups: those who received oral or enteral nutrition during the first 3 days of hospital admission (early nutrition group, n = 37 318) and those who did not (control group, n = 4159). One-to-one pair-matching was performed using propensity scores calculated via extreme gradient boosting to limit the confounding variables of the two groups. RESULTS After propensity score matching, 3541 pairs of patients were selected. The dependence of home discharge rates on early nutrition was significant (p < 0.05), and the effectiveness of early nutrition for home discharge showed an odds ratio of 1.79 (95% confidence interval of 1.59-2.03 in Fisher's exact test). CONCLUSIONS Our findings revealed that early nutritional initiation during the first 3 days of admission resulted in higher home discharge rates.
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Affiliation(s)
- Kazuto Ikezawa
- Division of Gastroenterology, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Mitsuaki Hirose
- Department of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Koichiro Yuji
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoshito Yabe
- Department of Nutrition, Tsukuba Memorial Hospital, Tsukuba, Japan
| | | | | | | | | | - Hideo Suzuki
- Department of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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27
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Louie DR, Simpson LA, Mortenson WB, Field TS, Yao J, Eng JJ. Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home. Phys Ther 2021; 102:6408936. [PMID: 34718796 PMCID: PMC8787995 DOI: 10.1093/ptj/pzab246] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/05/2021] [Accepted: 09/15/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. METHODS In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. RESULTS For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. CONCLUSION Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. IMPACT An early assessment of walking function within days of stroke admission can help to streamline discharge planning. LAY SUMMARY Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.
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Affiliation(s)
- Dennis R Louie
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - W Ben Mortenson
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Thalia S Field
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Vancouver Stroke Program, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, Canada
| | - Jennifer Yao
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Address all correspondence to Dr Eng at:
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28
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Bako AT, Bambhroliya A, Meeks J, Pan A, Potter T, Ifejika N, Vahidy FS. National Trends in Transfer of Patients with Primary Intracerebral Hemorrhage: An Analysis of 12-Year Nationwide Data. J Stroke Cerebrovasc Dis 2021; 30:106116. [PMID: 34562791 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The guidelines of the American Hospital Association encourage transferring intracerebral hemorrhage patients from community hospitals to centers with stroke expertise. However, research on the differences in outcomes between transferred intracerebral hemorrhage hospitalizations and directly admitted hospitalizations have been largely limited to small single-center studies. In this study, we explored the national trends in transferred intracerebral hemorrhage hospitalizations, as well as evaluated the differences, in terms of demographic characteristics, co-morbidity, resource utilization, and outcomes, between transferred intracerebral hemorrhage hospitalizations and directly admitted hospitalizations. MATERIALS AND METHODS From the National Inpatient Sample (2004 - 2016), we assessed the linear trends in the proportion of interhospital transfers for intracerebral hemorrhage hospitalizations. We constructed a series of multivariate logistic regression models to explore the association of transfer status with inpatient mortality and discharge disposition, controlling for demographic, clinical, and hospital characteristics. We used survey design variables to report nationally weighted estimates. RESULTS Among 786,999 hospitalizations, 137,340 (17.5%, 95% CI: 16.4-18.6) were transferred. Overall, interhospital transfers for intracerebral hemorrhage has been increasing over the 12-year period of this study. Patients in transferred hospitalizations were younger, more likely to be white, and more likely to have private insurance. Transferred hospitalizations were associated with significantly lower adjusted odds of inpatient mortality, compared to directly admitted hospitalizations. CONCLUSIONS As the US healthcare system continues shifting towards value-based care, evidence on the short- and long-term outcomes of transfer of intracerebral hemorrhage patients will inform optimal management of intracerebral hemorrhage patients.
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Affiliation(s)
- Abdulaziz T Bako
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Arvind Bambhroliya
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Jennifer Meeks
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Alan Pan
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Thomas Potter
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States
| | - Nneka Ifejika
- University of Texas Southwestern at Dallas, United States
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States; Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States.
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29
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Cho J, Place K, Salstrand R, Rahmat M, Mansouri M, Fell N, Sartipi M. Developing a Predictive Tool for Hospital Discharge Disposition of Patients Poststroke with 30-Day Readmission Validation. Stroke Res Treat 2021; 2021:5546766. [PMID: 34457232 PMCID: PMC8390171 DOI: 10.1155/2021/5546766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
After short-term, acute-care hospitalization for stroke, patients may be discharged home or other facilities for continued medical or rehabilitative management. The site of postacute care affects overall mortality and functional outcomes. Determining discharge disposition is a complex decision by the healthcare team. Early prediction of discharge destination can optimize poststroke care and improve outcomes. Previous attempts to predict discharge disposition outcome after stroke have limited clinical validations. In this study, readmission status was used as a measure of the clinical significance and effectiveness of a discharge disposition prediction. Low readmission rates indicate proper and thorough care with appropriate discharge disposition. We used Medicare beneficiary data taken from a subset of base claims in the years of 2014 and 2015 in our analyses. A predictive tool was created to determine discharge disposition based on risk scores derived from the coefficients of multivariable logistic regression related to an adjusted odds ratio. The top five risk scores were admission from a skilled nursing facility, acute heart attack, intracerebral hemorrhage, admission from "other" source, and an age of 75 or older. Validation of the predictive tool was accomplished using the readmission rates. A 75% probability for facility discharge corresponded with a risk score of greater than 9. The prediction was then compared to actual discharge disposition. Each cohort was further analyzed to determine how many readmissions occurred in each group. Of the actual home discharges, 95.7% were predicted to be there. However, only 47.8% of predictions for home discharge were actually discharged home. Predicted discharge to facility had 15.9% match to the actual facility discharge. The scenario of actual discharge home and predicted discharge to facility showed that 186 patients were readmitted. Following the algorithm in this scenario would have recommended continued medical management of these patients, potentially preventing these readmissions.
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Affiliation(s)
- Jin Cho
- Department of Computer Science and Engineering, University of Tennessee at Chattanooga, USA
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, USA
| | - Krystal Place
- Department of Physical Therapy, University of Tennessee at Chattanooga, USA
| | - Rebecca Salstrand
- Department of Physical Therapy, University of Tennessee at Chattanooga, USA
| | - Monireh Rahmat
- Department of Computer Science and Engineering, University of Tennessee at Chattanooga, USA
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, USA
| | - Misagh Mansouri
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, USA
| | - Nancy Fell
- Department of Physical Therapy, University of Tennessee at Chattanooga, USA
| | - Mina Sartipi
- Department of Computer Science and Engineering, University of Tennessee at Chattanooga, USA
- Center for Urban Informatics and Progress, University of Tennessee at Chattanooga, USA
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30
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McGlinchey MP, McKevitt C, Faulkner-Gurstein R, Sackley CM. The rehabilitation of physical function after severely disabling stroke: a survey of UK therapist practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Individuals who are severely disabled from stroke (survivors of severely disabling stroke) experience poorer outcomes compared to those who are less disabled from stroke. However, there is a paucity of evidence describing current therapy practice in the management of severely disabling stroke. The aim of the study was to describe intervention and outcome measure use by physiotherapists and occupational therapists in the rehabilitation of physical function of survivors of severely disabling stroke. Methods A mixed-methods survey was conducted, involving an online questionnaire and follow-up interviews. Survey participants were UK-based physiotherapists and occupational therapists with experience treating stroke. Questionnaire data were analysed with descriptive and inferential statistics. Interview data were analysed using content analysis. Results A total of 452 therapists (59% physiotherapists) responded to the questionnaire. Out of the respondents, 18 self-selected therapists participated in follow-up interviews to explain questionnaire data. Whole body positioning, training of upper limb handling and positioning, and sitting balance practice were the most frequently used interventions. Inpatient-based therapists performed more active rehabilitation interventions, whereas community-based therapists performed more training and education. The Barthel Index, Modified Rankin Scale and National Institutes for Health Stroke Scale were the most frequently used outcome measures. Outcome measure use was generally low and was more likely to be completed when it was part of a national audit. Reasons for low outcome measure use were perceived lack of time and insensitivity to detect clinical change. Conclusions A variety of interventions and outcome measures are used in the rehabilitation of survivors of severely disabling stroke. There is a need to evaluate the effectiveness of frequently used interventions and identify outcome measures that are sensitive to the needs of survivors of severely disabling stroke.
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Affiliation(s)
- Mark P McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Physiotherapy Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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31
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Chevalley O, Truijen S, Saeys W, Opsommer E. Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:4974-4985. [PMID: 34004119 DOI: 10.1080/09638288.2021.1923838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives. METHODS We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status. RESULTS Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01; 95%CI 7.38-130.18). CONCLUSION Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status.IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning.Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home.To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission.Further predictive factors for discharge home are cohabitation and marital status.
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Affiliation(s)
- Odile Chevalley
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Emmanuelle Opsommer
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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32
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Li TKT, Ng BHP, Chan DYL, Chung RSF, Yu KK. Factors predicting clinically significant functional gain and discharge to home in stroke in-patients after rehabilitation - A retrospective cohort study. Hong Kong J Occup Ther 2021; 33:63-72. [PMID: 33815025 PMCID: PMC8008375 DOI: 10.1177/1569186120979428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objective This study explored factors which predict stroke survivors who could achieve “clinically significant functional gain” and return home when being discharged from a local hospital after in-patient stroke rehabilitation programme. Methods This study included 562 inpatients with stroke who were residing at community dwellings before onset of stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main outcome variables of prediction were (a) achieving “clinically significant functional gain” as measured by (a1) achievement of “minimal clinically important difference” (MCID) of improvement in Functional Independence Measure Motor Measure (FIM-MM)”, (a2) one or more level(s) of improvement in function group according to the patients’ FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with univariate binary logistic regression and those significant variables were then put into multivariate binary logistic regression. Results Based on multivariate regression, the significant predictors for “clinically significant functional gain” were: younger age <75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, intermediate FIM-MM function group. Those significant predictors for “discharge to home” were: living with family/caregivers before stroke, higher FIM score at admission, and one or more level(s) of improvement in FIM-MM function group. Conclusions This study identified findings consistent with overseas studies in additional to some new interesting findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to focus on the use of appropriate intervention strategies and pre-discharge preparation.
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Affiliation(s)
| | | | | | | | - Kim-Kam Yu
- Department of Rehabilitation, Kowloon Hospital, HKSAR
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33
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Wu J, Misa O, Shiner CT, Faux SG. Targeted rehabilitation may improve patient flow and outcomes: development and implementation of a novel Proactive Rehabilitation Screening (PReS) service. BMJ Open Qual 2021; 10:bmjoq-2020-001267. [PMID: 33685858 PMCID: PMC7942267 DOI: 10.1136/bmjoq-2020-001267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/09/2022] Open
Abstract
Rehabilitation programmes can be delivered to patients receiving acute care (‘in-reach rehabilitation’) and/or those who have completed acute care but experience ongoing functional impairments (‘subacute rehabilitation’). Access to these programmes depends on a rehabilitation assessment, but there are concerns that referrals for this assessment are often triggered too late in the acute care journey. We describe a Proactive Rehabilitation Screening (PReS) process designed to systematically screen patients during an acute hospital admission, and identify early those who are likely to require specialist rehabilitation assessment and intervention. The process is based on review of patient medical records on day 5 after acute hospital admission, or day 3 after transfer from intensive care to an acute hospital ward. Screening involves brief review of documented care needs, pre-existing and new functional disabilities, the need for allied health interventions and non-medical factors delaying discharge. From May 2017 to February 2019, the novel screening process was implemented as part of a service redesign of the rehabilitation consultation service. Four thousand consecutive screens were performed at the study site. Of those ‘ruled in’ by screening as needing a rehabilitation assessment, 86.0% went on to receive inpatient rehabilitation interventions. Of those ‘ruled out’ by screening, 92.1% did not go on to receive a rehabilitation intervention, while 7.9% did receive some form of rehabilitation intervention. Of all patients accepted into a rehabilitation programme (n=516), PReS was able to identify 53.6% (n=282) of them before the acute care teams made a referral (based on traditional criteria). In conclusion, we have designed and implemented a systematic, PReS service in one metropolitan Australian hospital. The process described was found to be time efficient and feasible to implement in an acute hospital setting. Further, it appeared to identify the majority of patients who went on to receive formal inpatient rehabilitation interventions.
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Affiliation(s)
- Jane Wu
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Olivia Misa
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Christine T Shiner
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Steven G Faux
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
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van der Laag PJ, Arends SAM, Bosma MS, van den Hoogen A. Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis. Geriatr Nurs 2021; 42:83-93. [PMID: 33387828 DOI: 10.1016/j.gerinurse.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023]
Abstract
Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admitted to geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of early discharge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to present an overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation. Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factors were analysed via Bakker's five levels of evidence. Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extracted factors, limited (n=3), moderate (n=5) and conflicting (n=5) evidence found a significant association. Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantly related to successful rehabilitation. These factors could support healthcare professionals to indicate successful rehabilitation at admission and contributes to deployment of early discharge planning and development of more custom-made rehabilitation trajectories.
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Affiliation(s)
- Patricia J van der Laag
- Zorggroep Florence, Rijswijk, The Netherlands; Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Susanne A M Arends
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Stichting Humanitas, Rotterdam, The Netherlands
| | - Martine S Bosma
- Zorggroep Florence, Rijswijk, The Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Agnes van den Hoogen
- Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
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Sibolt G, Curtze S, Jokinen H, Pohjasvaara T, Kaste M, Karhunen PJ, Erkinjuntti T, Melkas S, Oksala NKJ. Post-stroke dementia and permanent institutionalization. J Neurol Sci 2021; 421:117307. [PMID: 33454589 DOI: 10.1016/j.jns.2020.117307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dementia is among the most frequent causes of institutionalization. To serve the purpose of preventive strategies, there are no follow-up studies that have evaluated the actual impact of post-stroke dementia on institutionalization. We therefore compared the institutionalization rate and length of stay in an institutional care facility of patients with post-stroke dementia with stroke patients without dementia. METHODS We included 410 consecutive patients aged 55 to 85 years with ischemic stroke who were admitted to Helsinki University Hospital (The SAM cohort). Hospitalization and nursing home admissions were reviewed from national registries. Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 3rd edition (DSM-III) criteria using extensive clinical assessments performed 3 months post-stroke. The cohort had a follow-up 21 years later. RESULTS Compared to patients without dementia, post-stroke dementia was associated with shorter survival time (6.60 vs 10.10 years, p < 0.001), shorter time spent not institutionalized (5.40 vs 9.37 years, p < 0.001), but not with time spent permanently institutionalized (0.73 vs 1.10 years, p = 0.08). Post-stroke dementia was associated with higher rates and earlier permanent institutionalization compared to absence of post-stroke dementia (HR 1.53, 95% CI 1.07-2.18) in a Cox regression model adjusting for age, status of living alone at baseline, modified Rankin Scale at baseline, history of atrial fibrillation, and cardiac failure. CONCLUSIONS Post-stroke dementia is associated with earlier permanent institutionalization. Due to significantly shorter survival, the time spent in nursing homes was not significantly longer in patients with post-stroke dementia compared with patients without post-stroke dementia.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland.
| | - Hanna Jokinen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tarja Pohjasvaara
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku Kaste
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Timo Erkinjuntti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Niku K J Oksala
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
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Ottiger B, Lehnick D, Pflugshaupt T, Vanbellingen T, Nyffeler T. Can I Discharge My Stroke Patient Home After Inpatient Neurorehabilitation? LIMOS Cut-Off Scores for Stroke Patients " Living Alone" and "Living With Family". Front Neurol 2020; 11:601725. [PMID: 33329360 PMCID: PMC7732616 DOI: 10.3389/fneur.2020.601725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Discharge planning of stroke patients during inpatient neurorehabilitation is often difficult since it depends both on the patient's ability to perform activities of daily living (ADL) and the social context. The aim of this study was to define ADL cut-off scores using the Lucerne ICF-based multidisciplinary observation scale (LIMOS) that allow the clinicians to decide whether stroke patients who "live alone" and "live with a family" can be discharged home or must enter a nursing home. Additionally, we investigated whether age and gender factors influence these cut-off scores. Methods: A single-center retrospective cohort study was conducted to establish cut-off discharge scores for the LIMOS. Receiver-operating-characteristics curves were calculated for both patient groups "living alone" and "living with family" to illustrate the prognostic potential of the LIMOS total score with respect to their discharge goals (home alone or nursing home; home with family or nursing home). A logistic regression model was used to determine the (age- and gender-adjusted) odds ratios of being released home if the LIMOS total score was above the cut-off. A single-center prospective cohort study was then conducted to verify the adequacy of the cut-off values for the LIMOS total score. Results: A total of 687 stroke inpatients were included in both studies. For the group "living alone" a LIMOS total score above 158 indicated good diagnostic accuracy in predicting discharge home (sensitivity 93.6%; specificity 95.4%). A LIMOS total cut-off score above 130 points was found for the group "living with family" (sensitivity 92.0%; specificity 88.6%). The LIMOS total score odds ratios, adjusted for age and gender, were 292.5 [95% CI: (52.0-1645.5)] for the group "living alone" and were 89.4 [95% CI: (32.3-247.7)] for the group "living with family." Conclusion: Stroke survivors living alone needed a higher ADL level to return home than those living with a family. A LIMOS total score above 158 points allows a clinician to discharge a patient that lives alone, whereas a lower LIMOS score above 130 points can be sufficient in a patient that lives with a family. Neither age nor gender played a significant role.
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Affiliation(s)
| | - Dirk Lehnick
- Clinical Trial Unit Central Switzerland, University of Lucerne, Lucerne, Switzerland
| | | | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Bern, Switzerland
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Asaithambi G, Tipps ME. Predictive value of discharge destination for 90-day outcomes among ischemic stroke patients eligible for endovascular treatment: Post-hoc analysis of DEFUSE 3. J Stroke Cerebrovasc Dis 2020; 29:104902. [PMID: 32689587 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The endovascular treatment (ET) for acute ischemic stroke (AIS) is increasing among eligible patients. To help address care quality, administrative data sets are utilized but do not usually include formal outcome scales. We explore the predictive ability of discharge destination from acute hospitalizations for long-term disability among AIS patients eligible for ET within a clinical trial. METHODS We analyzed publicly available data from the DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) trial. We evaluated patients who survived beyond the time of discharge from their acute hospitalizations. We calculated positive and negative predictive values and accompanying likelihood ratios for patients discharged to home, inpatient rehabilitation facility (IRF), or subacute nursing facility (SNF) for unfavorable outcome as defined by modified Rankin Scale (mRS) scores ≥3 at 90-days. RESULTS Our final analysis included 127 patients (median age 67 [23-89] years, 51.2% men). There were 23.6% patients discharged home, 53.5% to IRF, and 22.8% to SNF. Approximately 61% of patients had 90-day post-stroke mRS scores ≥3. Patients discharged to SNF had the highest positive predictive value (93.1%) and positive likelihood ratio (8.77 [CI 95% 2.18-35.25]) for unfavorable outcome. Discharge to home had the highest negative likelihood ratio (2.09 [CI 95% 1.54-2.83]) for unfavorable outcome. CONCLUSIONS Among AIS patients eligible for ET within the DEFUSE 3 trial, discharge destination can provide high predictive value of 90-day functional outcomes. A discharge to SNF is highly predictive of long-term unfavorable outcomes.
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Affiliation(s)
- Ganesh Asaithambi
- United Hospital Comprehensive Stroke Center, Allina Health, 310 North Smith Avenue, Suite 440, St. Paul 55102, MN, United States.
| | - Megan E Tipps
- Neuroscience Research, Allina Health, Minneapolis, MN, United States.
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Shumba J, McLoughlin A, Browne L, Schmid A, Wren MA, Hickey A, Kelly P, Bennett K, Rohde D, Sexton E. Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13055.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC. Patients and methods: PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic. Results: 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%]. Discussion and conclusion: Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.
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Kubo K, Kamo T, Momosaki R, Mitsutomi K. Development of a Point System to Predict Discharge to Home for Acute Stroke Patients. PM R 2020; 13:38-44. [PMID: 32248651 DOI: 10.1002/pmrj.12371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND While in an acute hospital setting, it is challenging for clinicians to make discharge decisions due to the multifactorial process and individual patient characteristics. OBJECTIVE To evaluate and develop a scoring system utilizing the Japan Rehabilitation Database (JRD) to identify acute stroke patients with a high possibility of discharge to home. DESIGN Retrospective observational cohort study. SETTING Thirty-seven acute hospitals in Japan. PARTICIPANTS A total of 10 270 patients admitted to the acute hospitals with stroke were identified. The inclusion criteria were (1) admission within 3 days of onset and (2) admission from home. Exclusion criteria were (1) incomplete data and (2) death in hospital. A total of 4216 patients were included in the study. INTERVENTION Not applicable. MAIN OUTCOME MEASUREMENTS Discharge destination from acute care hospital, that is, home versus other locations. RESULTS In the multivariate logistic regression, age, stroke type, Barthel Index on admission, modified Rankin scale on admission, the National Institutes of Health Stroke Scale on admission, and extent of paralysis were retained. When the cutoff point was 33, the scoring system showed a sensitivity of 80.4% and specificity of 80.3%. The area under curve (AUC) was 0.88. On evaluating the predictive performance, the model showed a sensitivity of 78.2% and a specificity of 78.5% with an AUC = 0.86. CONCLUSIONS We developed a point system to identify acute stroke patients with a high possibility of discharge to home using the JRD. This point system may provide useful information for clinicians to plan the discharge of acute stroke patients.
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Affiliation(s)
- Kosei Kubo
- Department of Rehabilitation Medicine, Iwata City Hospital, Iwata City, Japan
| | - Tomohiko Kamo
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, Satte City, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine Hospital Mizonokuchi, Kawasaki City, Japan
| | - Kazuhiko Mitsutomi
- Department of Rehabilitation Medicine, Iwata City Hospital, Iwata City, Japan
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Exploring discharge destination following severe stroke. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.Aim:The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.Method:A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.Results:The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.Conclusion:These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.
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Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home. Int J Rehabil Res 2020; 43:55-61. [DOI: 10.1097/mrr.0000000000000385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Satow T, Komuro T, Ogawa M. Premorbid instrumental activities of daily living predicts discharge home following stroke. eNeurologicalSci 2020; 18:100226. [PMID: 32055720 PMCID: PMC7005419 DOI: 10.1016/j.ensci.2020.100226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022] Open
Abstract
Background and purpose Stroke survivors who remain dependent require multiple healthcare resources, including rehabilitation and nursing care. The effect of premorbid instrumental ADL (IADL) on the discharge destination, which has not been studied previously in detail, is analyzed. Materials and methods Between April and September 2015, 40 stroke patients admitted to hospital were enrolled prospectively in the present study. The ADL (Barthel index) and IADL (Frenchay activities index: FAI) scores in their premorbid status were recorded. Baseline demographic data, stroke severity (NIHSS) and type of stroke, and whether they lived with family were also recorded. Simple univariate regression was performed between the two discharge destination groups (Home or Not Home). Significant factors were then included in multivariate logistic regression in order to determine the adjusted odds ratio for the discharge destination. A P value <.05 was taken as significant. Results 25 patients (64.1%) returned home. According to univariate analysis, NIHSS on admission and premorbid FAI were significantly associated with the discharge destination. Multivariate analysis found that NIHSS (OR, 0.71; 95% CI0.56–0.92; p = .008) and premorbid FAI (OR, 1.17; 95% CI1.03–1.33; p = .01) were independent predictors of the discharge destination. Conclusions Severity of stroke upon admission and premorbid IADL are associated with discharge destination following stroke. Predictors of discharge disposition after acute stroke were investigated in a Japanese rural community hospital. Stroke severity on admission and premorbid IADL are both correlated with the discharge destination following acute stroke. Improvement in the premorbid IADL of community dwellers might assist in reducing the consumption of healthcare resources.
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Affiliation(s)
- Takeshi Satow
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-8580, Japan
| | - Taro Komuro
- Department of Neurosurgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-8580, Japan
| | - Masafumi Ogawa
- Department of Neurology, Nagahama City Hospital, 313 Oinui-cho, Nagahama City, Shiga 526-8580, Japan
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Kim MS, Joo MC, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Kim SY, Oh GJ, Lee YS, Han EY, Han J, Ahn J, Chang WH, Kim YH, Choi JY, Hyun Kang S, Kim YT. Development and validation of a prediction model for home discharge in patients with moderate stroke: The Korean stroke cohort for functioning and rehabilitation study. Top Stroke Rehabil 2020; 27:453-461. [PMID: 31941411 DOI: 10.1080/10749357.2019.1711338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies have investigated the predictors for home discharge without considering stroke severity. OBJECTIVES To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals. METHODS Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model. RESULTS The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90). CONCLUSIONS This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients.
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Affiliation(s)
- Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine , Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine , Iksan, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University , Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine , Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School , Gwangju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital , Busan, Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital , Busan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine , Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital , Daegu, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine , Jeju, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University , Chuncheon, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University , Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
| | - Ji Yoo Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
| | - Sung Hyun Kang
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
| | - Young Taek Kim
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention,Center for Disease
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Hong I, Goodwin JS, Reistetter TA, Kuo YF, Mallinson T, Karmarkar A, Lin YL, Ottenbacher KJ. Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities. JAMA Netw Open 2019; 2:e1916646. [PMID: 31800069 PMCID: PMC6902754 DOI: 10.1001/jamanetworkopen.2019.16646] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE Health care reform legislation and Medicare plans for unified payment for postacute care highlight the need for research examining service delivery and outcomes. OBJECTIVE To compare functional outcomes in patients with stroke after postacute care in inpatient rehabilitation facilities (IRF) vs skilled nursing facilities (SNF). DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients with stroke who were discharged from acute care hospitals to IRF or SNF from January 1, 2013, to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. Data analyses were conducted from January 17, 2017, through April 25, 2019. EXPOSURES Inpatient rehabilitation received in IRFs vs SNFs. MAIN OUTCOMES AND MEASURES Changes in mobility and self-care measures during an IRF or SNF stay were compared using multivariate analyses, inverse probability weighting with propensity score, and instrumental variable analyses. Mortality between 30 and 365 days after discharge was included as a control outcome as an indicator for unmeasured confounders. RESULTS Among 99 185 patients who experienced a stroke between January 1, 2013, and November 30, 2014, 66 082 patients (66.6%) were admitted to IRFs and 33 103 patients (33.4%) were admitted to SNFs. A higher proportion of women were admitted to SNFs (21 466 [64.8%] women) than IRFs (36 462 [55.2%] women) (P < .001). Compared with patients admitted to IRFs, patients admitted to SNFs were older (mean [SD] age, 79.4 [7.6] years vs 83.3 [7.8] years; P < .001) and had longer hospital length of stay (mean [SD], 4.6 [3.0] days vs 5.9 [4.2] days; P < .001) than those admitted to IRFs. In unadjusted analyses, patients with stroke admitted to IRF compared with those admitted to SNF had higher mean scores for mobility on admission (44.2 [95% CI, 44.1-44.3] points vs 40.8 [95% CI, 40.7-40.9] points) and at discharge (55.8 [95% CI, 55.7-55.9] points vs 44.4 [95% CI, 44.3-44.5] points), and for self-care on admission (45.0 [95% CI, 44.9-45.1] points vs 41.8 [95% CI, 41.7-41.9] points) and at discharge (58.6 [95% CI, 58.5-58.7] points vs 45.1 [95% CI, 45.0-45.2] points). Additionally, patients in IRF compared with those in SNF had larger improvements for mobility score (11.6 [95% CI, 11.5-11.7] points vs 3.5 [95% CI, 3.4-3.6] points) and for self-care score (13.6 [95% CI, 13.5-13.7] points vs 3.2 [95% CI, 3.1-3.3] points). Multivariable, propensity score, and instrumental variable analyses showed a similar magnitude of better improvements in patients admitted to IRF vs those admitted to SNF. The differences between SNF and IRF in odds of 30- to 365-day mortality (unadjusted odds ratio, 0.48 [95% CI, 0.46-0.49]) were reduced but not eliminated in multivariable analysis (adjusted odds ratio, 0.72 [95% CI, 0.69-0.74]) and propensity score analysis (adjusted odds ratio, 0.75 [95% CI, 0.72-0.77]). These differences were no longer statistically significant in the instrumental variable analyses. CONCLUSIONS AND RELEVANCE In this cohort study of a large national sample, inpatient rehabilitation in IRFs for patients with stroke was associated with substantially improved physical mobility and self-care function compared with rehabilitation in SNFs. This finding raises questions about the value of any policy that would reimburse IRFs or SNFs at the same standard rate for stroke.
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Affiliation(s)
- Ickpyo Hong
- University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston
| | - James S. Goodwin
- University of Texas Medical Branch, School of Medicine, Sealy Center on Aging, Department of Internal Medicine, Galveston
| | - Timothy A. Reistetter
- University of Texas Health Science Center at San Antonio, School of Health Professions, Department of Occupational Therapy, San Antonio
| | - Yong-Fang Kuo
- University of Texas Medical Branch, School of Medicine, Sealy Center on Aging, Department of Preventive Medicine and Population Health, Galveston
| | - Trudy Mallinson
- George Washington University, School of Medicine and Health Sciences, Clinical Research and Leadership, Washington, DC
| | - Amol Karmarkar
- University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston; now with Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond
| | - Yu-Li Lin
- University of Texas Medical Branch, School of Medicine, Department of Preventive Medicine and Population Health, Galveston
| | - Kenneth J. Ottenbacher
- University of Texas Medical Branch, School of Health Professions, Sealy Center on Aging, Division of Rehabilitation Sciences, Galveston
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Wasserman A, Thiessen M, Pooyania S. Factors associated with community versus personal care home discharges after inpatient stroke rehabilitation: the need for a pre-admission predictive model. Top Stroke Rehabil 2019; 27:173-180. [DOI: 10.1080/10749357.2019.1682369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alexander Wasserman
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michelle Thiessen
- Department of Statistics and Epidemiology, University of Manitoba, Winnipeg, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Sinha K, Bettermann K. Clinical outcomes of moderate to severe acute ischemic stroke in a telemedicine network. J Clin Neurosci 2019; 69:160-165. [PMID: 31471078 DOI: 10.1016/j.jocn.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
Acute ischemic strokes (AIS) with severe neurologic deficits are associated with poor short- and long-term prognosis. Thrombectomy alone or in combination with thrombolysis is used for reperfusion in patients with moderate-to-severe AIS. However, the best therapeutic approach within the setting of telemedicine networks needs to be elucidated further. The objective of this study was to analyze clinical and imaging based outcomes of moderate to severe stroke following treatment with thrombolysis, thrombectomy or a combination of both in a telemedicine network. Data of this retrospective study was abstracted from the institutional telestroke database. Patients with a National Institute of Health Stroke Scale score (NIH-SS ≥ 10) were included into the study. Primary outcome measure was the difference in NIH-SS at admission compared to discharge from the hospital. Secondary outcome measure was the discharge disposition defined as favorable (discharge to home or rehabilitation) versus unfavorable disposition (discharge to hospice/death). Furthermore, outcome was analyzed based on reperfusion status following thrombectomy using the Thrombolysis in Cerebral Infarction (TICI) scale. The NIH-SS improved in all three groups, independent of treatment subtype, with a trend towards best outcomes following thrombolysis and combined treatment therapy compared to thrombectomy alone. In addition, reperfusion rates were higher in the combination group compared to the thrombectomy only group. The number of favorable discharges was similar in all three groups. The present study stresses the benefits of tele-stroke networks in allowing to early identify and treat even patients with severe strokes and benefit from different treatment modalities.
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Affiliation(s)
- Kusum Sinha
- Department of Neurology, Penn State College of Medicine, Hershey, PA, USA
| | - Kerstin Bettermann
- Department of Neurology, Penn State College of Medicine, Hershey, PA, USA.
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Sato M, Ido Y, Yoshimura Y, Mutai H. Relationship of Malnutrition During Hospitalization With Functional Recovery and Postdischarge Destination in Elderly Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:1866-1872. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/09/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023] Open
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Khan M, Heiser H, Bernicchi N, Packard L, Parker JL, Edwardson MA, Silver B, Elisevich KV, Henninger N. Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation. J Stroke Cerebrovasc Dis 2019; 28:1597-1603. [PMID: 30940427 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Leukoaraiosis has been shown to impact functional outcomes after acute ischemic stroke. However, its association with domain specific recovery after ischemic stroke is uncertain. We sought to determine whether pre-existing leukoaraiosis is associated with short-term motor and cognitive recovery after stroke. METHODS We retrospectively studied ischemic stroke patients admitted to acute inpatient rehabilitation (AIR) between January 2013 and September 2015. Patient baseline characteristics, infarct volume, prestroke modified Rankin Scale, stroke cause, rehabilitation length of stay, and Functional Independence Measure (FIM) scores were recorded. Leukoaraiosis severity was graded on brain magnetic resonance imaging using the Fazekas scale. Multiple linear regression was used to determine factors independently associated with the total, cognitive, and motor FIM scores at AIR discharge, respectively. RESULTS Of 1600 ischemic stroke patients screened, 109 patients were included in the final analysis. After adjustment, the initial National Institute of Health Stroke Scale (β -0.541, confidence interval [CI] -0.993 to -0.888; P = 0.020) and pre-existing leukoaraiosis severity (β -1.448, CI -2.861 to -0.034; P = 0.045) independently predicted the total FIM score. Domain specific analysis showed that infarct volume (β -0.012, CI -0.019 to -0.005; P = 0.002) and leukoaraiosis severity (β -0.822, CI -1.223 to -0.410; P = 0.0001) independently predicted FIM cognitive scores at discharge from AIR. Leukoaraiosis did not predict FIM motor score (P = 0.17). CONCLUSIONS Leukoaraiosis severity is an independent predictor of total and cognitive, but not motor FIM scores after AIR for acute ischemic stroke. This highlights that leukoaraiosis affects poststroke recovery in a domain specific fashion, information that may aid counseling of patients and families as well as tailor rehabilitative efforts.
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Affiliation(s)
- Muhib Khan
- Department of Clinical Neuroscience, Spectrum Health, College of Human Medicine, Michigan State University, MI; College of Human Medicine, Michigan State University, MI.
| | | | | | - Laurel Packard
- Department of Nursing Administration, Spectrum Health, MI
| | | | | | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, MA
| | - Kost V Elisevich
- Department of Clinical Neuroscience, Spectrum Health, College of Human Medicine, Michigan State University, MI; College of Human Medicine, Michigan State University, MI
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, MA; Department of Psychiatry, University of Massachusetts Medical School, MA
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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50
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Hayashi K, Yahata T, Muramoto R, Yamamoto N, Takeuchi A, Miwa S, Higuchi T, Abe K, Taniguchi Y, Aiba H, Araki Y, Tsuchiya H. Factors Associated With Discharge Destination in Advanced Cancer Patients With Bone Metastasis in a Japanese Hospital. Ann Rehabil Med 2018; 42:477-482. [PMID: 29961747 PMCID: PMC6058585 DOI: 10.5535/arm.2018.42.3.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/21/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
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Affiliation(s)
- Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsutaro Yahata
- Section of Physical and Rehabilitation Medicine, Central Medical Facilities, Kanazawa University Hospital, Kanazawa, Japan
| | - Ryota Muramoto
- Section of Physical and Rehabilitation Medicine, Central Medical Facilities, Kanazawa University Hospital, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kensaku Abe
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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