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Chandna M, Kumar A, Crippen M, Sakkal M, Guler M, Garg N, Tekumalla S, Barbarite E, Krein H, Heffelfinger R. Factors Predicting Discharge Disposition Following Head and Neck Free Flap Reconstruction. Laryngoscope 2024; 134:2721-2725. [PMID: 38098138 DOI: 10.1002/lary.31202] [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: 04/28/2023] [Revised: 09/12/2023] [Accepted: 10/17/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVES Patients undergoing head and neck free flap reconstruction (HNFFR) may have significant change to their baseline functional status requiring inpatient rehabilitation (IPR) after discharge. We sought to identify patient/procedure characteristics predictive of discharge destination. METHODS Patients undergoing elective HNFFR between July 2017 and July 2022 were reviewed for discharge destination. Those discharged to IPR versus home were compared across patient/procedure characteristics and physical/occupational therapy metrics. Significance was assessed via bivariate and multivariable analyses. RESULTS Of the 531 patients, 102 (19.2%) required IPR postoperatively. Patients discharged to IPR versus home were significantly older (70.1 [11.6] vs. 64.1 [13.1] years; p < 0.001) and more likely to lack family assistance (26.5% vs. 8.6%; p < 0.001), require baseline assistance for activities of daily living (ADLs) (31.4% vs. 9.8%; p < 0.001), have baseline cognitive dysfunction (15.7% vs. 6.1%; p = 0.001), were more likely to have neoplasm as the surgical indication for HNFFR (89.2% vs. 80.0%; p = 0.033) and more likely to have a tracheostomy postop (62.7% vs. 51.7%), and had a significantly longer length of stay (11.2 [8.0] vs. 6.8 [8.3] days; p < 0.001). There was no significant difference in gender, donor site, use of tube feeds, and use of assistive devices between the two groups. Following logistic regression, the strongest predictors of discharge to IPR include lack of family assistance (OR = 3.8; p < 0.001) and baseline assistance for ADLs (OR = 4.0, p < 0.001). CONCLUSION Certain patient factors predict the need for discharge to rehab after HNFFR. Perioperative identification of these factors may facilitate patient counseling and discharge planning with potential to reduce hospital length of stay and further optimize patient care. LEVEL OF EVIDENCE III Laryngoscope, 134:2721-2725, 2024.
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Affiliation(s)
- Megha Chandna
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Ayan Kumar
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Meghan Crippen
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Marah Sakkal
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Meryam Guler
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Neha Garg
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Sruti Tekumalla
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Eric Barbarite
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Howard Krein
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Ryan Heffelfinger
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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Cisek KK, Nguyen TNQ, Garcia-Rudolph A, Saurí J, Becerra Martinez H, Hines A, Kelleher JD. Predictors of social risk for post-ischemic stroke reintegration. Sci Rep 2024; 14:10110. [PMID: 38698076 PMCID: PMC11066106 DOI: 10.1038/s41598-024-60507-7] [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: 07/22/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
After stroke rehabilitation, patients need to reintegrate back into their daily life, workplace and society. Reintegration involves complex processes depending on age, sex, stroke severity, cognitive, physical, as well as socioeconomic factors that impact long-term outcomes post-stroke. Moreover, post-stroke quality of life can be impacted by social risks of inadequate family, social, economic, housing and other supports needed by the patients. Social risks and barriers to successful reintegration are poorly understood yet critical for informing clinical or social interventions. Therefore, the aim of this work is to predict social risk at rehabilitation discharge using sociodemographic and clinical variables at rehabilitation admission and identify factors that contribute to this risk. A Gradient Boosting modelling methodology based on decision trees was applied to a Catalan 217-patient cohort of mostly young (mean age 52.7), male (66.4%), ischemic stroke survivors. The modelling task was to predict an individual's social risk upon discharge from rehabilitation based on 16 different demographic, diagnostic and social risk variables (family support, social support, economic status, cohabitation and home accessibility at admission). To correct for imbalance in patient sample numbers with high and low-risk levels (prediction target), five different datasets were prepared by varying the data subsampling methodology. For each of the five datasets a prediction model was trained and the analysis involves a comparison across these models. The training and validation results indicated that the models corrected for prediction target imbalance have similarly good performance (AUC 0.831-0.843) and validation (AUC 0.881 - 0.909). Furthermore, predictor variable importance ranked social support and economic status as the most important variables with the greatest contribution to social risk prediction, however, sex and age had a lesser, but still important, contribution. Due to the complex and multifactorial nature of social risk, factors in combination, including social support and economic status, drive social risk for individuals.
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Affiliation(s)
- Katryna K Cisek
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland.
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic.
| | - Thi Nguyet Que Nguyen
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland
| | - Alejandro Garcia-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
| | - Joan Saurí
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | | | - Andrew Hines
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - John D Kelleher
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
- ADAPT Research Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic
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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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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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Ginex V, Viganò M, Gilardone G, Monti A, Gilardone M, Corbo M. Predicting home discharge after inpatient rehabilitation of stroke patients with aphasia. Neuropsychol Rehabil 2022; 33:393-408. [PMID: 37070855 DOI: 10.1080/09602011.2021.2021951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The early identification of the discharge setting from Inpatient Rehabilitation Facilities is a primary goal in stroke-related research because of its clinical and socio-economic relevance. Several features have been identified as significant predictors of the discharge setting. Within cognitive deficits, aphasia is known to be a common and disabling condition that could influence rehabilitation outcome. However, it is often set as an exclusion criterion in stroke research. This study aims to investigate the predictive power of clinical variables, in particular specific language disturbances and nonlinguistic cognitive deficits, for discharge setting in post-acute stroke patients with aphasia after intensive multidisciplinary rehabilitation. In a sample of 158 patients, demographic, motor, language, and nonverbal cognitive data were retrospectively considered for the prediction of the discharge to home vs. another institutional setting. Univariate analysis identified relevant differences between groups and the significant variables were included in a logistic regression model. The results showed that better functional motor status, absence of dysphagia and unimpaired nonlinguistic cognitive profile independently predict the discharge to home. In particular, nonverbal cognitive functioning seemed to be specifically relevant within the aphasic population. The findings could be helpful for setting up the rehabilitation priorities and an adequate discharge arrangement.
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Affiliation(s)
- Valeria Ginex
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Mauro Viganò
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Giulia Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Marco Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
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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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Roberts PS, Ouellette D, Solis N, Walters R, Chambers K, Brown D, DiVita MA. Retrospective study demonstrating therapy time impact on inpatient rehabilitation functional gains. Disabil Rehabil 2021; 44:4639-4647. [PMID: 33899629 DOI: 10.1080/09638288.2021.1912836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this retrospective study is to evaluate the association of total therapy time during inpatient rehabilitation and gain in functional independence for patients admitted to an inpatient rehabilitation facility (IRF). MATERIALS AND METHODS The study utilized a retrospective design that included all IRF patients from three IRFs in California from January 1, 2012 to December 31, 2013. Patient data collected as part of usual, routine medical, and rehabilitation care were used and includes demographics, medical variables, and functional outcomes data. RESULTS There were 3212 patients discharged from the three IRFs, with 2,777 patients having received speech language pathology (SLP) therapy along with occupational therapy and physical therapy. Speech language pathology services were not provided for 435 patients in the database. Our results support that among all types of patients, increased therapy hours were associated with increased functional gains. For total functional independence measure (FIM) gain, an additional hour of PT therapy per day was associated with an increase of 7.55 FIM gain points (p < 0.001) and an additional hour of OT therapy per day was associated with an increase of 1.16 FIM gain points (p = 0.045), when adjusted for other variables in the model. SLP hours per day did not remain in the FIM gain model. CONCLUSIONS The findings of this study add to the understanding of therapy time and functional gain in an inpatient rehabilitation program. There is a positive relationship between total therapy time and functional gain. In the future determining the intensity and the related therapy activities provided will be needed to impact functional change. This has implications for shaping rehabilitation practice in the future.Implications for rehabilitationIncreased number of therapy hours were associated with functional gains in an inpatient rehabilitation program for all types of patients.An additional hour of physical therapy per day was associated with an increase of 7.55 functional independence measure (FIM) point gain.An additional hour of occupational therapy per day was associated with an increase of 1.16 FIM point gain.Determining the intensity and related activities are needed to impact functional change which has implications for shaping rehabilitation practice.
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Affiliation(s)
- Pamela S Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
| | - Debra Ouellette
- Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Nuvia Solis
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
| | | | | | - David Brown
- Sharp Memorial Medical Center, San Diego, CA, USA
| | - Margaret A DiVita
- Health Department, State University of New York at Cortland, Cortland, NY, USA
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Abad ZSH, Maslove DM, Lee J. Predicting Discharge Destination of Critically Ill Patients Using Machine Learning. IEEE J Biomed Health Inform 2021; 25:827-837. [PMID: 32750906 DOI: 10.1109/jbhi.2020.2995836] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Decision making about discharge destination for critically ill patients is a highly subjective and multidisciplinary process, heavily reliant on the ICU care team, patients and their caregivers' preferences, resource demand, staffing, and bed capacity. Timely identification of discharge disposition can be useful in care planning, and as a surrogate for functional status outcomes following critical illness. Although prior research has proposed methods to predict discharge destination in a critical care setting, they are limited in scope and in the generalizability of their findings. We proposed and implemented different machine learning architectures to determine the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) IV score as well as the patient characteristics that comprise it to predict the discharge destination for critically ill patients within 24 hours of ICU admission. We conducted a retrospective study of ICU admissions within the eICU Collaborative Research Database (eICU-CRD) populated with de-identified clinical data from adult patients admitted to an ICU between 2014 and 2015. Machine learning models were developed to predict four discharge categories: death, home, nursing facility, and rehabilitation. These models were trained and tested on 115,248 unique ICU admissions. To mitigate class imbalance, we used synthetic minority over-sampling techniques. Hierarchical and ensemble classifiers were used to further study the impact of imbalanced testing set on the performance of our predictive models. Amongst all of the tested models, XGBoost provided the best discrimination performance with an area under the receiver operating characteristic curve of 90% (recall: 71%, F1: 70%). Our findings indicate that the variables used in the APACHE IV model for estimating patient severity of illness are better predictors of hospital discharge destination than the APACHE IV score alone. Incorporating these models into clinical decision support systems may assist patients, caregivers, and the ICU team to begin disposition planning as early as possible during the hospitalization.
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Akezaki Y, Nakata E, Kikuuchi M, Sugihara S. Factors Affecting the Discharge Destination of Patients With Spinal Bone Metastases. Ann Rehabil Med 2020; 44:69-76. [PMID: 32130840 PMCID: PMC7056331 DOI: 10.5535/arm.2020.44.1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/03/2019] [Indexed: 11/09/2022] Open
Abstract
Objective To investigate the factors affecting the discharge destination of patients with spinal bone metastases. Methods We reviewed the medical records of patients admitted to our institute with a diagnosis of skeletalrelated events secondary to malignant disease. Exclusion criteria comprised decreased cognitive function and hypercalcemia, brain metastasis, peritoneal dissemination, and pleural dissemination. The factors examined included the discharge destination, age, sex, the Barthel Index (BI) at admission and discharge, pain at admission and discharge, number of co-resident household members, length of hospital stay, treatment strategy, spinal instability neoplastic score, vertebral body collapse, spinal level of bone metastases, and motor paralysis. For the discharge destination, patients at discharge were grouped into two categories. The home group included patients discharged to their own homes, and the non-home group included patients discharged to other hospitals. Results Of 140 patients, the home group comprised 120 patients and the non-home group comprised 20 patients. Activities of daily living (ADL) and pain at rest and during motion improved significantly in the home group, whereas only pain at rest and during motion improved significantly in the non-home group. The results indicated that discharge BI and motor paralysis were the best predictors of the discharge destination; a BI cut-off value of 72.5 predicted discharge to home. Conclusion This study showed that the ADL level on discharge and motor paralysis affected the discharge destination of patients with spinal bone metastases. These results are likely to be helpful in predicting the discharge destination of patients with spinal bone metastases.
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Affiliation(s)
- Yoshiteru Akezaki
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi, Japan
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Masato Kikuuchi
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Shinsuke Sugihara
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
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Sultana I, Erraguntla M, Kum HC, Delen D, Lawley M. Post-acute care referral in United States of America: a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement. BMC Med Inform Decis Mak 2019; 19:223. [PMID: 31727058 PMCID: PMC6854767 DOI: 10.1186/s12911-019-0955-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background The use of post-acute care (PAC) for cardiovascular conditions is highly variable across geographical regions. Although PAC benefits include lower readmission rates, better clinical outcomes, and lower mortality, referral patterns vary widely, raising concerns about substandard care and inflated costs. The objective of this study is to identify factors associated with PAC referral decisions at acute care discharge. Methods This study is a retrospective Electronic Health Records (EHR) based review of a cohort of patients with coronary artery bypass graft (CABG) and valve replacement (VR). EHR records were extracted from the Cerner Health-Facts Data warehouse and covered 49 hospitals in the United States of America (U.S.) from January 2010 to December 2015. Multinomial logistic regression was used to identify associations of 29 variables comprising patient characteristics, hospital profiles, and patient conditions at discharge. Results The cohort had 14,224 patients with mean age 63.5 years, with 10,234 (71.9%) male and 11,946 (84%) Caucasian, with 5827 (40.96%) being discharged to home without additional care (Home), 5226 (36.74%) to home health care (HHC), 1721 (12.10%) to skilled nursing facilities (SNF), 1168 (8.22%) to inpatient rehabilitation facilities (IRF), 164 (1.15%) to long term care hospitals (LTCH), and 118 (0.83%) to other locations. Census division, hospital size, teaching hospital status, gender, age, marital status, length of stay, and Charlson comorbidity index were identified as highly significant variables (p- values < 0.001) that influence the PAC referral decision. Overall model accuracy was 62.6%, and multiclass Area Under the Curve (AUC) values were for Home: 0.72; HHC: 0.72; SNF: 0.58; IRF: 0.53; LTCH: 0.52, and others: 0.46. Conclusions Census location of the acute care hospital was highly associated with PAC referral practices, as was hospital capacity, with larger hospitals referring patients to PAC at a greater rate than smaller hospitals. Race and gender were also statistically significant, with Asians, Hispanics, and Native Americans being less likely to be referred to PAC compared to Caucasians, and female patients being more likely to be referred than males. Additional analysis indicated that PAC referral practices are also influenced by the mix of PAC services offered in each region.
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Affiliation(s)
- Ineen Sultana
- Department of Industrial and System Engineering, Texas A&M University, College Station, TX, USA.
| | - Madhav Erraguntla
- Department of Industrial and System Engineering, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Department of Industrial and System Engineering, Texas A&M University, College Station, TX, USA.,Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Dursun Delen
- Department of Management Science and Information Systems, Spears School of Business, Oklahoma State University, Stillwater, USA
| | - Mark Lawley
- Department of Industrial and System Engineering, Texas A&M University, College Station, TX, USA
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Kim SH, Shin YI, Kim SC, Ko SH, Kim DY, Lee J, Sohn MK, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Han J, Chang WH, Min JH, Kim YH. Factors Associated to Returning Home in the First Year after Stroke. BRAIN & NEUROREHABILITATION 2019; 13:e1. [PMID: 36744270 PMCID: PMC9879522 DOI: 10.12786/bn.2020.13.e1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/02/2019] [Accepted: 09/12/2019] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the 'Return home' group and 99 subjects in the 'Rehabilitation hospitalization' group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.
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Affiliation(s)
- Seung Han Kim
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Chan Kim
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Hwa Ko
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Deog Young Kim
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University, School of Medicine, Jeju, Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Iokawa K, Hasegawa K, Ishikawa T. Usefulness of the Daily Life Performance Transfer Sheet in Care Management of People With Stroke. Am J Occup Ther 2019; 73:7304205080p1-7304205080p7. [PMID: 31318672 DOI: 10.5014/ajot.2019.031468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the usefulness of collaboration between occupational therapists and care managers using the Daily Life Performance Transfer Sheet. METHOD We administered a questionnaire to obtain care managers' subjective assessments of the usefulness of the Daily Life Performance Transfer Sheet in the care management of clients with stroke 1 mo after discharge. RESULTS Most care managers perceived the Daily Life Performance Transfer Sheet as useful. Its perceived usefulness was significantly correlated with all items related to subjective assessment of care management, such as the understanding of clients' abilities, short-term care planning, long-term care planning, interprofessional collaboration, and sense of accomplishment. CONCLUSION The Daily Life Performance Transfer Sheet is a useful tool for care managers in the care management of clients with stroke.
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Affiliation(s)
- Kazuaki Iokawa
- Kazuaki Iokawa, PhD, OTR, is Professor, Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan;
| | - Keiichi Hasegawa
- Keiichi Hasegawa, MS, OTR, is Manager, Department of Rehabilitation, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Takashi Ishikawa
- Takashi Ishikawa, PhD, OTR, is Professor, Department of Occupational Therapy, Graduate School of Health Sciences, Akita University, Akita, Japan
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13
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Iokawa K, Hasegawa K, Ishikawa T. Possible Effectiveness of Collaboration between Occupational Therapists and Care Managers using the Management Tool for Daily Life Performance for Stroke Patients in Transitional Care. ACTA ACUST UNITED AC 2017. [DOI: 10.11596/asiajot.13.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kazuaki Iokawa
- Preparing section for New Faculty of Medical Science, Fukushima Medical University
- Division of Occupational Therapy, Department of Rehabilitation, Faculty of Health Science, Tohoku Fukushi University
| | | | - Takashi Ishikawa
- Department of Occupational Therapy, Graduate School of Health Sciences, Akita University
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14
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Mirkowski M, Pereira S, Janzen S, Mehta S, Meyer M, McClure A, Speechley M, Teasell R. Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation. Disabil Rehabil 2016; 40:457-461. [PMID: 28006999 DOI: 10.1080/09638288.2016.1260652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke. METHODS A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates. RESULTS Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p < 0.01), although both groups achieved a minimal clinically important difference. After controlling for age, gender, admission Functional Independence Measure, and length of hospital stay, caregiver availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p < 0.001). CONCLUSIONS The presence of a caregiver at time of discharge from inpatient rehabilitation is predictive of significantly higher functional ability at discharge in individuals with severe stroke. Implications for rehabilitation The availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke. The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.
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Affiliation(s)
| | | | - Shannon Janzen
- a Lawson Health Research Institute , London , Ontario , Canada
| | - Swati Mehta
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada
| | - Matthew Meyer
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada.,c London Health Sciences Centre , London , Ontario , Canada
| | - Andrew McClure
- a Lawson Health Research Institute , London , Ontario , Canada.,c London Health Sciences Centre , London , Ontario , Canada
| | | | - Robert Teasell
- a Lawson Health Research Institute , London , Ontario , Canada.,b Western University , London , Ontario , Canada.,d St. Joseph's Health Care London, Parkwood Institute , London , Ontario , Canada
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15
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Lewis ZH, Hay CC, Graham JE, Lin YL, Karmarkar AM, Ottenbacher KJ. Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities. Arch Phys Med Rehabil 2016; 97:2068-2075. [PMID: 27373747 PMCID: PMC5124404 DOI: 10.1016/j.apmr.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation, and examine the independent effects of social support on deviations from expected lengths of stay. DESIGN Retrospective cohort study. SETTING Inpatient rehabilitation facilities. PARTICIPANTS Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 after stroke, lower extremity fracture, or lower extremity joint replacement. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Relative length of stay (actual minus expected). The Centers for Medicare & Medicaid Services posts annual expected lengths of stay based on patients' clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. RESULTS Mean ± SD actual lengths of stay for joint replacement, fracture, and stroke were 9.8±3.6, 13.8±4.5, and 15.8±7.3 days, respectively; relative lengths of stay were -1.2±3.1, -1.6±3.7, and -1.7±5.2 days. Nearly half of patients (47%-48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (P<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement. CONCLUSIONS Inpatient rehabilitation experiences and outcomes can be substantially affected by a patient's level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures.
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Affiliation(s)
- Zakkoyya H Lewis
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Catherine Cooper Hay
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
| | - Yu-Li Lin
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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16
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Orme F, Gurr B. Cognitive change following stroke and its impact on long-term care. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.sup11.s543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims/Background: The outcomes of cognitive assessments after stroke provide important information for the implementation of immediate specialist interventions. This study investigated the trajectory of cognitive changes in an acute stroke sample. This was done by examining the relationship between cognitive changes following stroke as determined by the Montreal Cognitive Assessment (MoCA) and patients' discharge locations (own home, home with social care package, and placement). Method: The data of 124 hospitalised patients with acute stroke was retrospectively analysed. Patients' age ranged from 51 to 96 years, 77 patients were women and 47 were men. Data of post-stroke cognitive outcomes as represented by the MoCA results and discharge location were collected. Results: Patients' MoCA Mean outcome was 12.12 and Standard Deviation 7.77. Significant differences were found between patients with low post-stroke cognitive functioning, requiring more intensive care after discharge (i.e. placement), and those with better cognition, who subsequently were discharged home. The MoCA subdomain ‘Concentration and Calculation’ was associated most with discharge location. The study outcomes can potentially improve the efficiency of very early interventions and hospital discharge plans for acute stroke patients.
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Affiliation(s)
- Fiona Orme
- Assistant psychologist, Poole Stroke Unit, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Birgit Gurr
- Consultant clinical neuropsychologist, Dorset HealthCare NHS University Foundation Trust, Shaftesbury Road, Poole, UK
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17
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Wood AD, Gollop ND, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Flather MD, Potter JF, Myint PK. A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke. J Clin Neurol 2016; 12:407-413. [PMID: 27819414 PMCID: PMC5063865 DOI: 10.3988/jcn.2016.12.4.407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
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Affiliation(s)
- Adrian D Wood
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Joao H Bettencourt-Silva
- Norfolk and Norwich University Hospital, Norwich, UK.,Clinical Informatics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Allan B Clark
- Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | | | - Kristian M Bowles
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Marcus D Flather
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - John F Potter
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Phyo Kyaw Myint
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
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18
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Pereira S, Ross Graham J, Shahabaz A, Salter K, Foley N, Meyer M, Teasell R. Rehabilitation of Individuals With Severe Stroke: Synthesis of Best Evidence and Challenges in Implementation. Top Stroke Rehabil 2015; 19:122-31. [DOI: 10.1310/tsr1902-122] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Gorman SL, Harro CC, Platko C, Greenwald C. Examining the Function In Sitting Test for Validity, Responsiveness, and Minimal Clinically Important Difference in Inpatient Rehabilitation. Arch Phys Med Rehabil 2014; 95:2304-11. [DOI: 10.1016/j.apmr.2014.07.415] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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20
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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21
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Van der Cruyssen K, Vereeck L, Saeys W, Remmen R. Prognostic factors for discharge destination after acute stroke: a comprehensive literature review. Disabil Rehabil 2014; 37:1214-27. [DOI: 10.3109/09638288.2014.961655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lindenberg K, Nitz JC, Rahmann A, Bew P. Predictors of Discharge Destination in a Geriatric Population After Undergoing Rehabilitation. J Geriatr Phys Ther 2014; 37:92-8. [DOI: 10.1519/jpt.0b013e3182abe79e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Pereira S, Foley N, Salter K, McClure JA, Meyer M, Brown J, Speechley M, Teasell R. Discharge destination of individuals with severe stroke undergoing rehabilitation: a predictive model. Disabil Rehabil 2014; 36:727-31. [DOI: 10.3109/09638288.2014.902510] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Reliability of the Function in Sitting Test (FIST). Rehabil Res Pract 2014; 2014:593280. [PMID: 24757566 PMCID: PMC3976801 DOI: 10.1155/2014/593280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/21/2022] Open
Abstract
The function in sitting test (FIST) is a newly developed, performance-based measure examining deficits in seated postural control. The FIST has been shown to be internally consistent and valid in persons with neurological dysfunction but intra- and interrater reliability and test-retest reliability have not been previously described. Seven patients with chronic neurologic dysfunction were tested and videotaped performing the FIST on two consecutive days. Seventeen acute care and inpatient rehabilitation physical therapist raters scored six of the videotaped performance of the FIST on two occasions at least 2 weeks apart. Intraclass correlation coefficients were used to calculate the test-retest and intra- and interrater reliability of the FIST. ICC of 0.97 (95% CI 0.847–0.995) indicated excellent test-retest reliability of the FIST. Intra- and interrater reliability was also excellent with ICCs of 0.99 (95% CI 0.994–0.997) and 0.99 (95% CI 0.988–0.994), respectively. Physical therapists and other rehabilitation professionals can confidently use the FIST in a variety of clinical practice and research settings due to its favorable reliability characteristics. More studies are needed to describe the responsiveness and minimal clinically important level of change in FIST scores to further enhance clinical usefulness of this measure.
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25
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Tan S, Ramage L, McMurdo M, Witham M. Predicting failure to improve during rehabilitation for older patients using routinely collected clinical data. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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26
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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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28
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Pohl PS, Billinger SA, Lentz A, Gajewski B. The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large, US data base. Disabil Rehabil 2012; 35:990-4. [PMID: 23072650 DOI: 10.3109/09638288.2012.717587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine whether functional ability at admission and demographics predict discharge placement after inpatient rehabilitation for older adults recovering from stroke. METHOD In this retrospective study, we examined records of 31,910 adults 65 years of age and older who were admitted for inpatient rehabilitation post-stroke. Binary logistic regression was used with the outcome of placement and potential predictors of the admission Functional Independence Measure (FIM) score, age, sex and marital status. RESULTS The average admission FIM was 60.0 out of 126; the average FIM at discharge was 84.8. The mean age was 77.7 ± 7.3 years, 57% were female and 52.5% were not married. More than three quarters of the patients were discharged to home. Odds ratios (ORs) with 95% confidence intervals (CIs) showed that patients with a FIM score below the mean of our sample (OR = 5.8, CI = 5.5-6.2), older than the mean age of our sample (OR = 1.6, CI = 1.5-1.7), and who were not married (OR = 1.9, CI = 1.8-2.0) (p-values <0.001) were more likely to be discharged to residential care. Sex was not predictive of placement. CONCLUSION The admission FIM was an important predictor of discharge placement after rehabilitation in older adults. Age and marital status were also significant predictors of discharge placement. Sex was not a significant predictor.
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Affiliation(s)
- Patricia S Pohl
- Department of Physical Therapy, The Sage Colleges, Troy, NY 12180, USA.
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Luker JA, Bernhardt J, Grimmer-Somers KA. Demographic and stroke-related factors as predictors of quality of acute stroke care provided by allied health professionals. J Multidiscip Healthc 2011; 4:247-59. [PMID: 21847347 PMCID: PMC3155855 DOI: 10.2147/jmdh.s22569] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Indexed: 11/25/2022] Open
Abstract
Background: We recently indicated that patient age on its own is not a determinant of quality of allied health care received after an acute stroke. It has not been tested whether other non-age variables influence care decisions made by allied health professionals. This paper explores demographic and stroke-related variables that are putatively associated with the quality of care provided to acute stroke patients by allied health professionals. Methods: Data were retrospectively audited from 300 acute stroke patient records regarding allied health care. Compliance with each of 20 indicators of allied health care quality was established. The influence of various demographic and stroke-related variables on each performance indicator was examined. We undertook a series of analyses using univariate logistic regression models to establish the influence of these variables on care quality. Results: Patient age had a significant correlation with only one process indicator (early mobilization). Seven variables, including stroke severity and level of dependence, were associated with patient age. The majority of these age proxies had significant associations with process indicator compliance. Correlations between non-age variables, in particular stroke severity and comorbidity, suggest the potential for complex confounding relationships between non-age variables and quality of allied health care. Conclusion: Compliance with individual indicators of allied health care was significantly associated with variables other than patient age, and included stroke severity, previous independence, comorbidities, day of admission, stroke unit admission, and length of stay. The inter-relationships between these non-age variables suggest that their influence on quality of care is complex.
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Affiliation(s)
- Julie A Luker
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia
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Further Validation of the Balance Outcome Measure for Elder Rehabilitation. Arch Phys Med Rehabil 2011; 92:101-5. [DOI: 10.1016/j.apmr.2010.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 11/17/2022]
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Jupp BJ, Mallela SK, Kwan J, Allen S, Sharma JC, Vassallo M. Development and evaluation of the GEMS (gait, eyesight, mental state, sedation) tool as an aid to predict outcome after hospitalization. Geriatr Gerontol Int 2010; 11:8-15. [DOI: 10.1111/j.1447-0594.2010.00626.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Development and validation of the Function In Sitting Test in adults with acute stroke. J Neurol Phys Ther 2010; 34:150-60. [PMID: 20716989 DOI: 10.1097/npt.0b013e3181f0065f] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Research studies indicate that sitting balance ability is a substantial predictor of functional recovery after stroke. There are no gold standards for sitting balance assessment, and commonly used balance measures do not isolate sitting balance abilities. This study was designed to develop, pilot test, and analyze reliability and validity of a short test of functional sitting balance in patients following acute stroke. METHODS The Function In Sitting Test (FIST) was constructed after reviewing balance measures and interviewing 15 physical therapists. A written survey regarding the FIST items and scoring scales was designed, pilot tested, and sent to 12 additional physical therapists with expertise in measurement construction, balance assessment, and/or research. Thirty-one adults who were within 3 months following stroke participated in this study. RESULTS The expert panel survey was returned by 83.3% of the participants. Survey feedback and weighted rank analysis reduced the number of FIST items from 26 to 17. After subject testing, Item Response Theory analysis eliminated 3 additional items. The person separation index was 0.978 and the coefficient alpha was 0.98, indicating high internal consistency of the FIST. The Item Response Theory analysis confirmed content and construct validity. Concurrent validity was supported by high correlations to the modified Rankin Scale, static balance indices, and dynamic balance grades. DISCUSSION AND CONCLUSIONS The 14-item FIST is reliable and valid in adults following acute stroke. Studies of intra- or intertester reliability and evaluative validity studies including applications to other patient populations with sitting balance dysfunction are now necessary.
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Di Monaco M, Trucco M, Di Monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil 2010; 24:543-54. [DOI: 10.1177/0269215509353265] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To compare the predictive validity of trunk control in sitting position assessed by Trunk Impairment Scale and balance in lying, sitting and standing posture assessed by Postural Assessment Scale for Stroke patients on functional outcome in stroke survivors. Design: Prospective observational study. Setting: A single rehabilitation hospital in Italy. Subjects: Sixty of 68 consecutive subjects admitted to a rehabilitation hospital after stroke. Main measures: We performed Trunk Impairment Scale and Postural Assessment Scale for Stroke patients at admission to inpatient rehabilitation. Outcome measures at discharge were Functional Independence Measure score and destination (classified as either home or institution). Results: After adjustment for 14 potential confounders, including Functional Independence Measure score at admission to rehabilitation, both Trunk Impairment Scale and Postural Assessment Scale for Stroke patients scores were significantly associated with the Functional Independence Measure score at discharge (P = 0.010 and P =0.04, respectively), change in the Functional Independence Measure score during rehabilitation (P = 0.003 and P<0.001, respectively), Functional Independence Measure effectiveness (P = 0.024 and P =0.017, respectively) and destination at discharge (P = 0.040 and P =0.032, respectively). The panel of prognostic variables predicted 64—65% of the variance in the final Functional Independence Measure score, 30—35% of the variance in the change of the Functional Independence Measure score during rehabilitation, and 45—46% of the variance in the Functional Independence Measure effectiveness depending on the inclusion of either Trunk Impairment Scale or Postural Assessment Scale for Stroke patients score among the predictors.
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Affiliation(s)
- Marco Di Monaco
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo,
| | - Marco Trucco
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo
| | | | - Rosa Tappero
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Turin, Italy
| | - Alberto Cavanna
- Division of Physical Medicine and Rehabilitation, Presidio Sanitario San Camillo, Turin, Italy
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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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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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Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc 2010; 57:2101-6. [PMID: 20121954 DOI: 10.1111/j.1532-5415.2009.02526.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the effect of dysphasia and dysphagia on stroke outcome. DESIGN Retrospective database study. SETTING Norfolk, United Kingdom. PARTICIPANTS Two thousand nine hundred eighty-three men and women with stroke admitted to the hospital between 1997 and 2001. MEASUREMENTS Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria. RESULTS Two thousand nine hundred eighty-three patients (1,330 (44.6%) male), median age 78 (range 17-105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8-2.7) and 1.4 (95% CI=1.2-1.6) for dysphasia; 12.5 (95% CI=8.9-17.3) and 3.9 (95% CI=3.3-4.6) for dysphagia, 5.5 (95% CI=3.7-8.2), 1.9 (95% CI=1.6-2.3) for either, and 13.8 (95% CI=9.4-20.4) and 3.7 (95% CI=3.1-4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively. CONCLUSION Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity or results from problems related directly to dysphagia is unclear.
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Affiliation(s)
- Veronique Guyomard
- Stroke Unit, Department of Medicine for the Elderly, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norfolk NR4 7TJ, United Kingdom.
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Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke 2008; 40:e18-23. [PMID: 19109540 DOI: 10.1161/strokeaha.108.529776] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE With decision-analytic models becoming more popular to assess the cost-effectiveness of health care interventions, the need for robust estimates on the costs of cerebrovascular disease is paramount. This study reports the results from a literature review of the costs of cerebrovascular diseases, and assesses the quality of the published evidence against a set of defined criteria. METHODS A broad literature search was conducted. Those studies reporting mean/median costs of cerebrovascular diseases derived from patient-level data in a developed country setting were included. Data were abstracted using standardized reporting forms and assessed against 4 predefined criteria: use of adequate methodologies, use of a population-based study, inclusion of premorbid resource use, and reporting of costs by different patient subgroups. RESULTS A total of 120 cost studies were identified. The cost estimates of stroke were compared by taking into account the effects of inflation and price differentials between countries. Average costs of stroke ranged from $468 to $146 149. Differences in costs were also found within country, with estimates in the USA varying 20-fold. Although the costing methodologies used were generally appropriate, only 5 studies were based on population-based studies, which are the gold standard study design when comparing incidence, outcome, and costs. CONCLUSIONS This review showed large variations in the costs of stroke, mainly attributable to differences in the populations studied, methods, and cost categories included. The wide range of cost estimates could lead to selection bias in secondary health economic analyses, with authors including those costs that are more likely to produce the desired results.
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Affiliation(s)
- Ramon Luengo-Fernandez
- Department of Public Health, Health Economics Research Centre, University of Oxford, Oxford, USA.
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Postacute Levels of Care for Stroke Survivors. Prof Case Manag 2008; 13:236-9. [DOI: 10.1097/01.pcama.0000327415.91546.1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Myint PK, Vowler SL, Redmayne O, Fulcher RA. Cognition, Continence and Transfer Status at the Time of Discharge from an Acute Hospital Setting and Their Associations with an Unfavourable Discharge Outcome after Stroke. Gerontology 2008; 54:202-9. [DOI: 10.1159/000126491] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 01/24/2008] [Indexed: 11/19/2022] Open
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Abstract
Rehabilitation is influenced by the individual's abilities and resources and extent to which they are used. This study explored self-actualization (capacity to maximize use of one's abilities and resources) in 37 individuals attending in-patient rehabilitation following a stroke by (1) comparing the level of self-actualization of the participants to the level of self-actualization of 562 healthy community-dwelling individuals without stroke; (2) assessing changes in the level of self-actualization during rehabilitation (admission vs. discharge); and (3) exploring the relationships between self-actualization and changes in functional independence during rehabilitation, length of stay in the rehabilitation unit and change in living environment at discharge. Self-actualization was assessed with the measure of actualization of potential. The results showed that individuals with stroke had significantly lower self-actualization levels (P<0.001) than community-dwelling individuals without stroke. Self-actualization levels remained stable during rehabilitation (P=0.07). No significant relationships were found between self-actualization and changes in functional independence (P=0.36), length of stay (P=0.82) or change in living environment (P=0.65). This study suggests that many individuals with stroke are poorly actualized and self-actualization levels do not improve during rehabilitation. Further studies are needed to explore the relationship between self-actualization and other outcome measures in poststroke rehabilitation such as depressive symptoms or social participation.
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Affiliation(s)
- Mélanie Couture
- Research Centre on Ageing, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Québec, Canada.
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Ng YS, Stein J, Salles SS, Black-Schaffer RM. Clinical Characteristics and Rehabilitation Outcomes of Patients With Posterior Cerebral Artery Stroke. Arch Phys Med Rehabil 2005; 86:2138-43. [PMID: 16271561 DOI: 10.1016/j.apmr.2005.07.289] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 06/21/2005] [Accepted: 07/05/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the demographics, clinical profile, and functional outcomes in posterior cerebral artery (PCA) stroke and to identify factors associated with functional change during rehabilitation and discharge disposition. DESIGN Retrospective study of patients with PCA stroke admitted to a rehabilitation hospital over an 8-year period. SETTING Free-standing urban rehabilitation hospital in the United States. PARTICIPANTS Eighty-nine consecutive patients with PCA stroke (48 men, 41 women; mean age, 71.5y) met inclusion criteria. INTERVENTION Inpatient multidisciplinary comprehensive rehabilitation program. MAIN OUTCOME MEASURES Demographic, clinical, and discharge disposition information were collected. Functional status was measured using the FIM instrument, recorded at admission and discharge. The main outcome measures were the discharge total FIM score, the change in total FIM score (DeltaFIM), and the discharge disposition. Multiple and logistic regression analyses were performed to identify factors associated with the main outcome measures. RESULTS The most common impairments were motor paresis (65%), followed by visual field defects (54%) and confusion or agitation (43%). The mean discharge total FIM score +/- standard deviation was 88.3+/-28.2. The mean DeltaFIM was 23.3+/-16.4. Fifty-five (62%) patients were discharged home. On multiple regression analysis, higher admission total FIM score, longer length of stay (LOS), and a rehabilitation stay free of interruptions were associated with higher discharge total FIM score and greater DeltaFIM. Absence of diabetes mellitus and younger age were also associated with higher discharge total FIM scores, and male sex had greater DeltaFIM. On logistic regression analysis, younger patients, higher discharge FIM scores, presence of a caregiver, and the nonnecessity for 24-hour support were associated with a discharge to home. CONCLUSIONS Motor, visual, and cognitive impairments are common in PCA stroke, and good functional gains are achievable after comprehensive rehabilitation. Higher admission FIM scores, longer LOS, and younger and male patients were associated with better functional outcomes. Most patients were discharged home, particularly those with caregivers and those for whom 24-hour support was not required. Further research should aim at the development of functional outcome measures of greater breadth and sensitivity to visual and cognitive deficits and should compare PCA stroke outcomes with outcomes of strokes in other vascular territories.
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Affiliation(s)
- Yee Sien Ng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
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Pérennou D, Decavel P, Manckoundia P, Penven Y, Mourey F, Launay F, Pfitzenmeyer P, Casillas JM. [Evaluation of balance in neurologic and geriatric disorders]. ACTA ACUST UNITED AC 2005; 48:317-35. [PMID: 15932776 DOI: 10.1016/j.annrmp.2005.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 04/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyse the clinical usefulness and metrological properties of the main techniques and indices used to assess balance disorders. METHODS More than 4000 abstracts referenced in MEDLINE and dealing with postural control and postural disorders (wide screening) were reviewed to determine the main postural techniques and indices used in a clinical context. We retained abstracts with a high citation frequency and those with interesting findings. Corresponding key words were identified for a specific search of articles that we analysed. RESULTS Postural assessment tools can be classified as scales of ordinal items, tests based on metric or chronometric measurement, posturography, and verticality perception. These techniques are complementary, and their association is recommended in a clinical context. Regarding generic tools, the Falls-related Efficacy Scale (FES) and the Activities-specific Balance Confidence scale (ABC scale) would be enhanced if comparatively analysed and reworked to allow for a feasible and reliable assessment of the fear of falling. Despite a wide diffusion in numerous postural fields worldwide, the Berg Balance Scale (BBS) and the Functional Reach Test (FRT) do not have the required criteria to remain the gold standards they were in the 1990s. Static posturography should be normalised and yield more reliable indices. The clinical relevance of the subjective assessment of visual, haptic, and postural verticals are questionable, especially to explain postural disability. Regarding specific tools, the Tinetti test (TT) and the Time Up and Go test (TUG) are the most suited to assess postural capacities in very elderly people, in whom the predictive validity of the postural assessment of falls is still modest. In stroke patients, the Postural Assessment Scale for Stroke (PASS), posturography, lateropulsion assessment, and vertically perception are interesting and complementary techniques. Postural assessment relies mainly upon the 5 postural items of the Unified Parkinson Disease Rating Scale (UPDRS) in people with Parkinson disease and upon the Romberg test and posturography in patients with cerebellar or proprioceptive ataxia. Some novel postural scales for patients with multiple sclerosis or spinal cord injury are also emerging. CONCLUSION Among numerous tools that contribute to the assessment of postural disorders, only the most recent ones (developed in the last 10 years) have undergone complete validation. It is now crucial to compare these tools, not only in terms of reproducibility and internal consistency, but also overall, in terms of feasibility, responsiveness, and predictive validity for a given population.
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Affiliation(s)
- D Pérennou
- Pôles rééducation-réadaptation et gériatrie, CHU et Inserm ERM207, 23, rue Gaffarel, BP 77908 F, 21079 Dijon cedex, France.
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