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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: 9] [Impact Index Per Article: 3.0] [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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Branco JP, Oliveira S, Páscoa Pinheiro J, L. Ferreira P. Assessing upper limb function: transcultural adaptation and validation of the Portuguese version of the Stroke Upper Limb Capacity Scale. BMC Sports Sci Med Rehabil 2017; 9:15. [PMID: 28785412 PMCID: PMC5543451 DOI: 10.1186/s13102-017-0078-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/23/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Brachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS. METHODS A Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients (n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity. RESULTS Semantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS). CONCLUSIONS The present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.
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Affiliation(s)
- João Paulo Branco
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro – Rovisco Pais, Tocha, Portugal
| | - Sandra Oliveira
- Physical and Rehabilitation Medicine Department, Centro de Medicina de Reabilitação da Região Centro – Rovisco Pais, Tocha, Portugal
| | - João Páscoa Pinheiro
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Pedro L. Ferreira
- Faculty of Economics, University of Coimbra, Coimbra, Portugal
- Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal
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Prediction of Advisability of Returning Home Using the Home Care Score. Rehabil Res Pract 2015; 2015:501042. [PMID: 26491568 PMCID: PMC4602329 DOI: 10.1155/2015/501042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care.
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Tseng HP, Lin FJ, Chen PT, Mou CH, Lee SP, Chang CY, Chen AC, Liu CH, Yeh CH, Tsai SY, Hsiao YJ, Lin CH, Hsu SP, Yu SC, Hsu CY, Sung FC. Derivation and validation of a discharge disposition predicting model after acute stroke. J Stroke Cerebrovasc Dis 2015; 24:1179-86. [PMID: 25847306 DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. METHODS We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. RESULTS Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). CONCLUSIONS The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.
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Affiliation(s)
- Hung-Pin Tseng
- Department of Neurology, Lotung Pohai Hospital, Lotung, Ilan, Taiwan
| | - Feng-Jenq Lin
- Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan
| | - Pi-Tzu Chen
- Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chun-Yuan Chang
- Department of Neurology, Min Sheng General Hospital, Taoyuan, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsiang Liu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsin Yeh
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Song-Yen Tsai
- Department of Neurology, Changhua Christian Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yu-Jen Hsiao
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Ching-Huang Lin
- Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Yu
- Department of Neurology, Kuang Tien General Hospital Dajia Division, Taichung, Taiwan
| | - Chung-Y Hsu
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
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Bates BE, Xie D, Kwong PL, Kurichi JE, Cowper Ripley D, Davenport C, Vogel WB, Stineman MG. Development and Validation of Prognostic Indices for Recovery of Physical Functioning Following Stroke: Part 1. PM R 2015; 7:685-698. [PMID: 25633632 DOI: 10.1016/j.pmrj.2015.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a prognostic index using Functional Independence Measure grades and stages that would enable clinicians to determine the likelihood of achieving a level of minimum assistance with physical functioning after a stroke. Grades define varying levels of physical function, and stages define varying levels of cognitive functioning. DESIGN Retrospective cohort study. SETTING Veterans Affairs Medical Centers throughout the United States. PARTICIPANTS Veterans with a diagnosis of a new stroke discharged between October 1, 2006, and September 30, 2008, who were below physical grade IV (requiring minimal assistance) at initial rehabilitation assessment. MAIN OUTCOME MEASURE Achievement of physical grade IV or above at final rehabilitation assessment. RESULTS Physical grade IV was reached by 25.8% of participants who were initially below this grade. Seven variables remained independently predictive of physical grade IV after adjustment. These variables were assigned the following points: age, ≤69 years = 2, 70-79 years = 1, ≥80 years = 0; initial physical grade, I = 0, II = 3, III = 4; initial cognitive stage, I or II = 0, III = 2, IV or V = 3, VI or VII = 4; absence of renal failure = 1; no serious nutritional compromise = 3; the type of rehabilitation services received, consultative = 0, comprehensive = 4; and recovery time between admission and discharge physical grade assessment, 1-2 days = 0, 3-7 days = 4, and ≥8 days = 5. The area under the receiver operating characteristic curve was 0.84 and 0.83 for the point system in the derivation and validation cohorts, respectively. The Hosmer-Lemeshow statistic was not significant (P = .93) in the derivation cohort, indicating that the regression model demonstrated adequate fit. The proportions of patients recovered to physical grade IV in the first (score ≥9), second (score = 10-12), third (score = 13-15), and fourth (score >15) score quartiles were 2.72%, 11.38%, 28.96%, and 60.34%, respectively. CONCLUSION By using a simple tool, clinicians can forecast the likelihood of recovery to or above the physical grade IV benchmark by the conclusion of rehabilitation services during the acute stroke hospitalization.
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Affiliation(s)
- Barbara E Bates
- Physical Medicine and Rehabilitation, Samuel S. Stratton Veterans Affairs Medical Center, 113 Holland Ave, Albany, NY 12208.,Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Diane Cowper Ripley
- VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - Claire Davenport
- Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY
| | - W Bruce Vogel
- VA Center for Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.,Department of Health Outcomes and Policy, University of Florida, College of Medicine, Gainesville, FL
| | - Margaret G Stineman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.,Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA
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Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RTCM. Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis. BMC Health Serv Res 2012; 12:443. [PMID: 23211058 PMCID: PMC3537742 DOI: 10.1186/1472-6963-12-443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022] Open
Abstract
Background Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. Methods This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Results Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Conclusion Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
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Affiliation(s)
- Bianca I Buijck
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P,O,Box 9101, Nijmegen, 6500 HB, the Netherlands.
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Spruit-van Eijk M, Zuidema SU, Buijck BI, Koopmans RTCM, Geurts ACH. Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study. Age Ageing 2012; 41:746-52. [PMID: 22885846 DOI: 10.1093/ageing/afs105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity. DESIGN prospective cohort study with data collection at baseline and at discharge. SETTING fifteen SNFs in the Netherlands. PARTICIPANTS of 378 eligible patients, 186 were included. METHODS multi-disciplinary teams recorded demographic and disease characteristics, as well as functional status, cognitive functioning and multi-morbidity on admission. The study outcomes were discharge to an independent living situation within 1 year of admission and functional status at discharge (Barthel index). RESULTS of the included 186 patients, 175 were followed up. Of these patients, 123 (70%) were successfully discharged. High Berg Balance Scale (BBS) and Star Cancellation test (SCT) scores independently contributed to 48% of the variance of functional status at discharge, while low age, high BBS and SCT scores were independently related to successful discharge, explaining 33% of the variance. Multi-morbidity was not an independent determinant of rehabilitation outcome. CONCLUSION geriatric patients admitted for 'low intensity' rehabilitation in SNFs after stroke appeared to have a fair prognosis for being successfully discharged. Postural control was an important determinant of both outcome measures.
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Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
Discharge to community is an important outcome measure for rehabilitation facilities. Studies consistently find that stroke patients with higher scores on the Functional Independence Measure (FIM) are more likely to be discharged to the community. Other variables, including age, gender, and living status, also have shown a relationship to discharge destination for stroke patients. This study explored the differences between stroke patients who were discharged to the community and those who were discharged to a nursing home after a stay on an acute inpatient rehabilitation unit. Results indicated that older patients and those with lower admission FIM scores are more likely to be discharged to nursing homes, but many patients who fit this profile are discharged to the community. The main destination determinant was how well a patient's need for care matched informal caregiving resources. These findings indicate a need for additional focused assessment of available care giving resources.
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Affiliation(s)
- Barbara J Lutz
- Center for Patient-Centered Informational Interventions, University of Wisconsin-Madison, School of Nursing, USA.
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Dombrowski W, Yoos JL, Neufeld R, Tarshish CY. Factors predicting rehospitalization of elderly patients in a postacute skilled nursing facility rehabilitation program. Arch Phys Med Rehabil 2012; 93:1808-13. [PMID: 22555006 DOI: 10.1016/j.apmr.2012.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/31/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine potential risk factors for rehospitalization of skilled nursing facility (SNF) rehabilitation patients. DESIGN Retrospective review of rehabilitation charts. SETTING SNF rehabilitation beds (n=114) at a 514-bed urban, academic nursing home that receives patients from tertiary care hospitals. PARTICIPANTS Consecutive rehabilitation patients (n=50) who were rehospitalized during days 4 to 30 of rehabilitation, compared with a matched group of rehabilitation patients (n=50) who were discharged without rehospitalization. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Data on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation examination and laboratory values. The clinical conditions precipitating rehospitalizations were noted. RESULTS Sixty-two percent of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia (P=.001) and malignant solid tumors (P<.001), index hospitalizations involving a gastrointestinal condition (P=.001), needed more assistance with eating (P=.001) and walking (P=.03), and had lower hemoglobin (P=.002) and albumin levels (P<.001). A logistic regression model found that the strongest predictors for rehospitalization are a history of a malignant solid tumor (odds ratio [OR]=10.10), a recent hospitalization involving gastrointestinal conditions (OR=4.62), and a low serum albumin level (with each unit decrease in albumin, the odds of rehospitalization are 4 times greater [OR=.24, P=.005]). CONCLUSIONS Comorbid conditions, reasons for index hospitalization, and laboratory values are associated with an increased risk for rehospitalization. Further studies are needed to identify high-risk elderly patients and target interventions to minimize rehospitalizations.
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Affiliation(s)
- Wen Dombrowski
- Department of Medical Affairs, Jewish Home Lifecare, New York, NY, USA
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Okuno Y, Miyasaka T, Dobashi K. Factors Influencing the Outcome of Acute Rehabilitation: Functional Independence Measure Assessment at Discharge. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yukako Okuno
- Department of Rehabilitation, Kan-etsu Chuo Hospital
- Department of Physical Therapy, Faculty of Health Sciences, Uekusa Gakuen University
| | - Tomoya Miyasaka
- Department of Physical Therapy, Faculty of Health Sciences, Uekusa Gakuen University
| | - Kunio Dobashi
- Department of Physical Therapy, Faculty of Health Sciences, Uekusa Gakuen University
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Rehabilitation Outcomes in a Population of Nonagenarians and Younger Seniors With Hip Fracture, Heart Failure, or Cerebral Vascular Accident. Arch Phys Med Rehabil 2010; 91:1505-10. [DOI: 10.1016/j.apmr.2010.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/22/2010] [Accepted: 07/06/2010] [Indexed: 12/20/2022]
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Appelros P, Nydevik I, Terént A. Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences. Disabil Rehabil 2010; 28:43-9. [PMID: 16393832 DOI: 10.1080/09638280500165278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.
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Affiliation(s)
- Peter Appelros
- Department of Urology, Orebro University Hospital, Sweden.
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13
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Ilett PA, Brock KA, Graven CJ, Cotton SM. Selecting patients for rehabilitation after acute stroke: are there variations in practice? Arch Phys Med Rehabil 2010; 91:788-93. [PMID: 20434618 DOI: 10.1016/j.apmr.2009.11.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether there were variations in practice in selection for rehabilitation after stroke, after adjustment for case mix. DESIGN Prospective multicenter audit. SETTING Seven acute stroke units in metropolitan and regional Victoria, Australia. PARTICIPANTS Consecutive acute stroke admissions (N=616). INTERVENTIONS None. MAIN OUTCOME MEASURES Mobility Scale for Acute Stroke Score and Modified Barthel Index (MBI) scores for continence at day 3 poststroke, discharge destination from the acute hospital. RESULTS Data were analyzed for 616 stroke survivors. Considerable variability in the percentage of cases accessing inpatient rehabilitation was observed in severe stroke (27%-67%) and mild stroke (27%-73%). To assess adjustment for case mix, a multinomial logistic regression was conducted with the outcome variable being discharge destination (home, rehabilitation, or nursing home), and the predictors being Mobility Scale for Acute Stroke Score, MBI continence scores, age, and social situation. The overall amount of variability explained in discharge destination by the predictors was 63% (Nagelkerke pseudo R(2)). The regression analysis was repeated, adding unit code as a predictor. Unit code was a significant contributor to the model (P<.01). CONCLUSION The results of the study indicate that, after adjusting for case mix, there may be variations in practice in selection for rehabilitation leading to inequities of access.
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Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Arch Phys Med Rehabil 2010; 91:345-50. [PMID: 20298822 DOI: 10.1016/j.apmr.2009.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. DESIGN Retrospective cross-sectional design. SETTING Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. PARTICIPANTS Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Discharge FIM rating and discharge setting (community vs institutional). RESULTS Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). CONCLUSIONS Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings.
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Spruit-van Eijk M, Buijck BI, Zuidema SU, Voncken FLM, Geurts ACH, Koopmans RTCM. Geriatric rehabilitation of stroke patients in nursing homes: a study protocol. BMC Geriatr 2010; 10:15. [PMID: 20346175 PMCID: PMC2858723 DOI: 10.1186/1471-2318-10-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature. METHODS/DESIGN This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation.Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation. DISCUSSION This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients.
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Affiliation(s)
- Monica Spruit-van Eijk
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen- Medical Centre, Geert Grooteplein 21 Nijmegen 6525 EZ, the Netherlands.
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16
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Fulk GD, Echternach JL, Nof L, O'Sullivan S. Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract 2009; 24:195-204. [DOI: 10.1080/09593980701588284] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. METHODS Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. RESULTS The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. DISCUSSION The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.
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Affiliation(s)
- Sue Berger
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA.
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