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Nawarat J, Chaipinyo K. Construction of Mobility to Participation Assessment Scale for Stroke (MPASS) and Testing its Validity and Reliability in Persons with Stroke. J Prev Med Public Health 2022; 55:334-341. [PMID: 35940188 PMCID: PMC9371778 DOI: 10.3961/jpmph.21.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jiraphat Nawarat
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Kanda Chaipinyo
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhonnayok, Thailand
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Biggs J. The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke. Phys Ther 2020; 100:2165-2173. [PMID: 32886786 DOI: 10.1093/ptj/pzaa158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/14/2019] [Accepted: 08/02/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). METHODS Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. RESULTS Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. CONCLUSIONS Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. IMPACT The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.
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Affiliation(s)
- Jennifer Biggs
- Doctor of Physical Therapy Program, St Catherine University, 2004 Randolph Ave, St Paul, MN 55105 (USA). Dr Biggs is a certified wound specialist
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McGlinchey MP, James J, McKevitt C, Douiri A, Sackley C. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review. BMJ Open 2020; 10:e033642. [PMID: 32029489 PMCID: PMC7045156 DOI: 10.1136/bmjopen-2019-033642] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke. DESIGN Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength. RESULTS 28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence. CONCLUSIONS There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required. PROSPERO REGISTRATION NUMBER CRD42017077737.
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Affiliation(s)
- Mark P McGlinchey
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Jimmy James
- Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Abdel Douiri
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College School, London, UK
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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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Kobylańska M, Kowalska J, Neustein J, Mazurek J, Wójcik B, Bełza M, Cichosz M, Szczepańska-Gieracha J. The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work 2019; 61:523-535. [PMID: 30475778 PMCID: PMC6398539 DOI: 10.3233/wor-162823] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: A large proportion of individuals with a stroke are unable to return to work, although figures vary greatly. Due to the very high cost of post-stroke care, both tangible and intangible, in the form of long-term social consequences, it seems extremely important to search for factors responsible for the low efficiency of the rehabilitation and recovery process, because this fact has direct influence on future employment. Such knowledge would enable physiotherapists to quickly identify those patients who are at risk of rehabilitation breakdown, in order to provide them with special care and include them in intensive therapeutic treatments. OBJECTIVE: The aim of the study was to assess the efficacy of post-stroke rehabilitation, evaluated within the biopsychosocial aspect. METHODS: The study consisted of 120 patients after first stroke, including 48 women and 72 men aged 58.0 (±8.6). The measure of the effects of physiotherapy in the present study was not only the improvement of the functional state (simple and complex activities of daily life, locomotive activities), but also the improvement of the mental state (mood and the sense of well-being, level of acceptance of illness, perceived self-efficacy) and the reduction of pain. The Mini-Mental State Examination, the Geriatric Depression Scale, the Generalized Self-Efficacy Scale, the Acceptance of Illness Scale, the Visual Analogue Scale, the Barthel Index, the Instrumental Activity of Daily Living and the Rivermead Mobility Index were used. All parameters were measured twice: on admission to the ward and after three weeks of physiotherapy. The characteristics of the study group were presented using descriptive statistics. The analysis of interdependence of the efficacy of physiotherapy used two non-parametric tests: the Mann-Whitney U test to compare two groups, and the Kruskal-Wallis ANOVA test to compare a greater number of groups. Correlations between characteristics with continuous distributions were assessed using Spearman’s rank correlation coefficient (ρ), and in case of categorical variables, Pearson’s chi-squared (χ2) correlation coefficient. Linear regression was used to determine the hierarchy of the influence of particular characteristics on the efficacy of physiotherapy. RESULTS: Statistical analyzes show that patient’s age, time since stroke, number of comorbidities, family care capacity, marital status of the patient and also a low level of acceptance of illness, depression symptoms and lack of a sense of self-efficacy were related with low efficacy of post-stroke rehabilitation CONCLUSIONS: Comprehensive neurological rehabilitation, taking into account mental challenges and socio-economic circumstances of individuals with a stroke is essential in order to achieve high efficacy of physiotherapy. Important external factors may play a pivotal role in returning to work as well and should be taken into account during rehabilitation. Of interest should be to assess more biopsychological factors, such as acceptance of illness and a sense of self-efficacy referred to as barriers to return to work.
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Affiliation(s)
- Marzena Kobylańska
- Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland
| | - Joanna Kowalska
- Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland
| | - Jolanta Neustein
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Justyna Mazurek
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Bartosz Wójcik
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Małgorzata Bełza
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Michał Cichosz
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
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McGlinchey MP, James J, McKevitt C, Douiri A, McLachlan S, Sackley CM. The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review. Syst Rev 2018; 7:197. [PMID: 30447698 PMCID: PMC6240323 DOI: 10.1186/s13643-018-0870-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/02/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stroke rehabilitation aims to optimise function and reduce complications post-stroke. Rehabilitation to optimise physical function post-stroke has beneficial effects for survivors of mild to moderate stroke. However, little is known about the effectiveness of interventions to rehabilitate physical function or manage immobility-related complications for survivors of severe stroke. The systematic review aims to evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke and identify topics for future research in this area. METHODS A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, AMED, PEDro, DORIS and CENTRAL) between January 1987 and July 2017 will be undertaken to identify eligible published randomised controlled trials (RCTs) in any language. Ongoing RCTs will be identified by searching health-care trial registers (Stroke Trials Registry, ClinicalTrials.gov). Hand searches of identified study reference lists will also be performed. The PRISMA statement will be used to guide the systematic review. Two reviewers will screen search results, select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Studies comparing the effect of one type of rehabilitation intervention to another or usual care on physical function and immobility-related complications for patients with severe stroke will be included. Studies may include participants with all levels of stroke severity but must provide sub-group analysis based on stroke severity. Studies will focus on any phase of the stroke rehabilitation pathway and will be grouped and analysed according to their timeframe post-stroke into acute and early sub-acute (up to 3 months post-stroke), early sub-acute to late sub-acute (from 3 to 6 months post-stroke) and chronic (greater than 6 months post-stroke). If sufficient studies demonstrate homogeneity, a meta-analysis will pool results of individual outcomes. The GRADE approach will be used to assess the evidence strength. DISCUSSION The results of this systematic review will summarise the strength of evidence for rehabilitation interventions used in the rehabilitation of physical function and immobility-related complications in severe stroke and identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)-registration number CRD77737 .
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Affiliation(s)
- Mark P. McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Jimmy James
- Physiotherapy Department, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Sarah McLachlan
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
| | - Catherine M. Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL England
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Kose E, Hirai T, Seki T, Hayashi H. The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients. Int J Clin Pharm 2018; 40:599-607. [DOI: 10.1007/s11096-018-0610-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/21/2018] [Indexed: 01/25/2023]
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Does activity limitation predict discharge destination for postacute care patients? Am J Phys Med Rehabil 2015; 93:782-90. [PMID: 24800717 DOI: 10.1097/phm.0000000000000097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to examine the ability of different domains of activity limitation to predict discharge destination (home vs. nonhome settings) 1 mo after hospital discharge for postacute rehabilitation patients. DESIGN A secondary analysis was conducted using a data set of 518 adults with neurologic, lower extremity orthopedic, and complex medical conditions followed after discharge from a hospital into postacute care. Variables collected at baseline include activity limitations (basic mobility, daily activity, and applied cognitive function, measured by the Activity Measure for Post-Acute Care), demographics, diagnosis, and cognitive status. The discharge destination was recorded at 1 mo after being discharged from the hospital. RESULTS Correlational analyses revealed that the 1-mo discharge destination was correlated with two domains of activity (basic mobility and daily activity) and cognitive status. However, multiple logistic regression and receiver operating characteristic curve analyses showed that basic mobility functioning performed the best in discriminating home vs. nonhome living. CONCLUSIONS This study supported the evidence that basic mobility functioning is a critical determinant of discharge home for postacute rehabilitation patients. The Activity Measure for Post-Acute Care-basic mobility showed good usability in discriminating home vs. nonhome living. The findings shed light on the importance of basic mobility functioning in the discharge planning process.
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Rose T, Worrall L, Hickson L, Hoffmann T. Do People With Aphasia Want Written Stroke and Aphasia Information? A Verbal Survey Exploring Preferences for When and How to Provide Stroke and Aphasia Information. Top Stroke Rehabil 2015; 17:79-98. [DOI: 10.1310/tsr1702-79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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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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Burns AS, Yee J, Flett HM, Guy K, Cournoyea N. Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury. Spinal Cord 2012; 51:165-9. [PMID: 22847654 DOI: 10.1038/sc.2012.91] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Performance improvement initiative. OBJECTIVES To improve efficiency of spinal cord rehabilitation by reducing length of stay (LOS) while maintaining or improving patient outcomes. SETTING Academic hospital in Canada. METHODS LOS benchmarking was completed using national comparator data from the Canadian Institute for Health Information (CIHI). Clinical decision-making tools were developed to support implementation and sustainability. A standardized 'tentative discharge date' calculator was created to establish objective LOS targets. Defined discharge criteria and an accompanying clinical decision tree were developed to support team decision making and improve transparency. A revised patient census tool was also implemented to improve team communication and facilitate data collection. The initiative was implemented in March 2010 and the following metrics were evaluated: LOS, Functional Independence Measure (FIM) change and FIM efficiency. RESULTS Outcomes are reported for the 2010/11 fiscal year, and compared with the two prior fiscal years. Mean LOS for individuals undergoing initial inpatient rehabilitation was 71.5 days for 2010/11, a 14 and 17% reduction compared with the 2008/09 and 2009/10 fiscal years, respectively. While LOS decreased, FIM change increased 9 and 16% compared with 2008/09 and 2009/10, respectively. Similarly, FIM efficiency increased 54 and 32% compared with 2008/09 and 2009/10. CONCLUSION The use of benchmarking and decision support tools improved rehabilitation efficiency while increasing standardization in practice and transparency in LOS determination.
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Affiliation(s)
- A S Burns
- Department of Medicine, Division of Physiatry, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Discharge to community is an important outcome measure for rehabilitation facilities. Studies consistently find that stroke patients with higher scores on the Functional Independence Measure (FIM) are more likely to be discharged to the community. Other variables, including age, gender, and living status, also have shown a relationship to discharge destination for stroke patients. This study explored the differences between stroke patients who were discharged to the community and those who were discharged to a nursing home after a stay on an acute inpatient rehabilitation unit. Results indicated that older patients and those with lower admission FIM scores are more likely to be discharged to nursing homes, but many patients who fit this profile are discharged to the community. The main destination determinant was how well a patient's need for care matched informal caregiving resources. These findings indicate a need for additional focused assessment of available care giving resources.
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Affiliation(s)
- Barbara J Lutz
- Center for Patient-Centered Informational Interventions, University of Wisconsin-Madison, School of Nursing, USA.
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Lo A, Tahair N, Sharp S, Bayley MT. Clinical utility of the AlphaFIM® instrument in stroke rehabilitation. Int J Stroke 2011; 7:118-24. [PMID: 22103839 DOI: 10.1111/j.1747-4949.2011.00694.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. AIM To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. METHODS In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. RESULTS The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. CONCLUSIONS The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.
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Affiliation(s)
- Alexander Lo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Mutai H, Furukawa T, Araki K, Misawa K, Hanihara T. Factors associated with functional recovery and home discharge in stroke patients admitted to a convalescent rehabilitation ward. Geriatr Gerontol Int 2011; 12:215-22. [PMID: 21929733 DOI: 10.1111/j.1447-0594.2011.00747.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed to determine the predictive factors for functional recovery and home discharge in stroke patients receiving in-hospital rehabilitation. METHODS This study included a consecutive series of 174 stroke patients (average age 73.0 ± 10.8) admitted to the convalescent rehabilitation ward at Azumino Red Cross Hospital in Japan after acute rehabilitation. The main outcome measures were functional recovery (functional independence measure [FIM] at discharge and Montebello rehabilitation factor score [MRFS]) and home discharge. RESULTS Total FIM improved from 72.6 ± 27.6 to 87.7 ± 29.9 during the hospital stay (P < 0.001). The average MRFS was 0.30 ± 0.28. Of the 174 patients, 151 were discharged home (87%). Age, stroke type, premorbid independence, motor FIM, and cognitive FIM at admission showed a significant association with FIM at discharge, while age, premorbid independence, motor FIM at admission, and cognitive FIM at admission were statistically significant predictors of MRFS. Female sex, not living with family, premorbid independence, and neglect were negatively associated with home discharge. CONCLUSIONS Premorbid disability and cognitive dysfunction at admission were both negatively associated with functional recovery and home discharge in patients undergoing inpatient stroke rehabilitation.
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Affiliation(s)
- Hitoshi Mutai
- Department of Rehabilitation, Azumino Red Cross Hospital, Azumino, Japan
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Poststroke Discharge Destination: Functional Independence and Sociodemographic Factors in Urban Japan. J Stroke Cerebrovasc Dis 2011; 20:202-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.11.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 11/30/2009] [Indexed: 11/19/2022] Open
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Kohler F, Renton R, Dickson HG, Estell J, Connolly CE. Subacute casemix classification for stroke rehabilitation in Australia. How well does AN-SNAP v2 explain variance in outcomes? AUST HEALTH REV 2011; 35:1-8. [DOI: 10.1071/ah09806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 03/28/2010] [Indexed: 11/23/2022]
Abstract
Objective. We sought the best predictors for length of stay, discharge destination and functional improvement for inpatients undergoing rehabilitation following a stroke and compared these predictors against AN-SNAP v2. Method. The Oxfordshire classification subgroup, sociodemographic data and functional data were collected for patients admitted between 1997 and 2007, with a diagnosis of recent stroke. The data were factor analysed using Principal Components Analysis for categorical data (CATPCA). Categorical regression analyses was performed to determine the best predictors of length of stay, discharge destination, and functional improvement. Results. A total of 1154 patients were included in the study. Principal components analysis indicated that the data were effectively unidimensional, with length of stay being the most important component. Regression analysis demonstrated that the best predictor was the admission motor FIM score, explaining 38.9% of variance for length of stay, 37.4%.of variance for functional improvement and 16% of variance for discharge destination. Conclusion. The best explanatory variable in our inpatient rehabilitation service is the admission motor FIM. AN- SNAP v2 classification is a less effective explanatory variable. This needs to be taken into account when using AN-SNAP v2 classification for clinical or funding purposes. What is known about the topic? AN-SNAP v2, a major classification tool for inpatient rehabilitation units has been described and used in a small number of published studies. The ability to predict variance by AN-SNAP v2 has not been previously described. What does this paper add? This paper indicates that AN-SNAP v2 is not a good predictor of outcomes in patients in medical rehabilitation units, challenging its utility as a classification tool. What are the implications for practitioners? Practitioners will have a broader understanding of the strengths and weaknesses of the AN-SNAP v2 classification.
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Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Arch Phys Med Rehabil 2010; 91:345-50. [PMID: 20298822 DOI: 10.1016/j.apmr.2009.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/11/2009] [Accepted: 11/13/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. DESIGN Retrospective cross-sectional design. SETTING Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. PARTICIPANTS Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Discharge FIM rating and discharge setting (community vs institutional). RESULTS Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). CONCLUSIONS Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings.
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Paolucci A, McKenna K, Cooke DM. Factors affecting the number and type of impairments of visual perception and praxis following stroke. Aust Occup Ther J 2009; 56:350-60. [DOI: 10.1111/j.1440-1630.2008.00743.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cooke DM, Gustafsson L, Tardiani DL. Clock drawing from the occupational therapy adult perceptual screening test: Its correlation with demographic and clinical factors in the stroke population. Aust Occup Ther J 2009; 57:183-9. [DOI: 10.1111/j.1440-1630.2009.00795.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cooke DM, McKenna K, Fleming J, Darnell R. Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). Scand J Occup Ther 2009; 13:49-61. [PMID: 16615415 DOI: 10.1080/11038120500363014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n = 356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.
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Affiliation(s)
- Deirdre M Cooke
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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Cooke DM, McKenna K, Fleming J, Darnell R. Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). Scand J Occup Ther 2009; 13:38-48. [PMID: 16615414 DOI: 10.1080/11038120500363006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA--Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants' performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.
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Affiliation(s)
- Deirdre M Cooke
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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Brauer SG, Bew PG, Kuys SS, Lynch MR, Morrison G. Prediction of Discharge Destination After Stroke Using the Motor Assessment Scale on Admission: A Prospective, Multisite Study. Arch Phys Med Rehabil 2008; 89:1061-5. [DOI: 10.1016/j.apmr.2007.10.042] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 10/02/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
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San Segundo RM, Aguilar JJ, Santos F, Usabiaga T. A model for predicting delay in discharge of stroke patients. ACTA ACUST UNITED AC 2007; 50:14-9. [PMID: 16884809 DOI: 10.1016/j.annrmp.2006.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 06/29/2006] [Indexed: 11/26/2022]
Abstract
AIMS To study the factors that predict delay in discharge (DD) for stroke victims when they are admitted to hospital and to build a model for predicting DD in our hospital. METHOD A retrospective study of 214 stroke victims admitted to the Physical Medicine and Rehabilitation Service (PMRS) of a general hospital between January 1, 1994, and December 31, 2001. Seventeen clinical and sociodemographic data were studied to determine which factors were predictors of DD: age, sex, type of stroke, side affected, sphincter control, ability to communicate, level of consciousness, deep sensitivity, antecedents of cardiovascular risk, delay before admission to the PMRS, initial functional state and solitude, whether the patient was employed prior to the cerebrovascular accident, and whether the patient's place of residence had any exterior architectural barriers. RESULTS A total of 26.6% of patients experienced DD. Factors influencing DD were solitude (odds ratio [OR] 6; 95% confidence interval [CI] 2.2-16.1), an initial functional independence measure (FIM) below 50 (OR 4.5; 95% CI 2.3-8.9) and age greater than 75 years (OR 2.7; 95% CI 1.2-6.1). The best model for predicting DD comprises seven variables: solitude, initial FIM below 50, older than 75 years, left hemiparesis, exterior architectonic barriers at home, cardiovascular antecedents and sex (male). This model has a specificity of 89% and a sensitivity of 40%. CONCLUSION Solitude, low initial FIM and age older than 75 years influence DD for patients with stroke admitted to hospital. A model for predicting DD is described.
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Affiliation(s)
- R M San Segundo
- Adjunct Medical Officer of the Physical Medicine and Rehabilitation Service of the Sant Pau i Santa Tecla Hospital, Tarragona, Spain
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Cooke DM, McKenna K, Fleming J, Darnell R. Australian normative data for the Occupational Therapy Adult Perceptual Screening Test. Aust Occup Ther J 2006. [DOI: 10.1111/j.1440-1630.2006.00597.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rieck M, Moreland J. The Orpington Prognostic Scale for patients with stroke: reliability and pilot predictive data for discharge destination and therapeutic services. Disabil Rehabil 2006; 27:1425-33. [PMID: 16418057 DOI: 10.1080/09638280500330435] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge. METHOD Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed. RESULTS The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 - 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 - 0.98). The accuracy for predicting discharge to home using OPS 5.0 was 65% (95% CI 0.52 - 0.76). OPS scores were not related to number of follow-up services prescribed. CONCLUSIONS Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.
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Affiliation(s)
- Mary Rieck
- Therapy Services Department, Joseph Brant Memorial Hospital, Burlington, Ontario, Canada
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Kuo YF, Ostir GV, Granger CV, Ottenbacher KJ. Examination of Follow-up Therapy in Patients with Stroke. Am J Phys Med Rehabil 2006; 85:192-200. [PMID: 16505634 DOI: 10.1097/01.phm.0000200418.04179.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Examine the patterns and effect of follow-up therapy for persons with stroke. DESIGN Retrospective analysis of national inpatient medical rehabilitation facilities and follow-up survey data from 1994 to 2001. A total of 45,164 patients received inpatient medical rehabilitation after a stroke. The mean age (+/- standard deviation) was 69.5 (+/-12.8) yrs, 48% were women, and 77% were non-Hispanic white. Average length of stay was 21.9 (+/-14.2) days. RESULTS The highest gain in FIM instrument ratings for follow-up therapy was associated with a discharge FIM rating of > or =65. Patients with FIM ratings > or =65 at discharge who received follow-up therapy gained an average of 19.4 points between discharge and follow-up assessment compared with a mean gain of 15.1 points for persons who did not receive follow-up therapy. Validity was examined using 100 bootstrap replications. The percentage of persons with FIM instrument scores of > or =65 receiving follow-up therapy increased from 38% in 1994 to 58% in 2001. CONCLUSIONS The differences in postdischarge FIM gains between patients with and without follow-up therapy were greatest among patients with discharge FIM instrument ratings of > or =65. Compared with patients whose discharge FIM ratings were >65, patients with discharge FIM scores of > or =65 who underwent follow-up therapy demonstrated substantially greater average postdischarge FIM gains than those with FIM ratings of >65.
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Affiliation(s)
- Yong-Fang Kuo
- Sealy Center on Aging, Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas 77555-0460, USA
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Abstract
Background and Purpose—
Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia.
Methods—
406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes.
Results—
AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type.
Conclusions—
AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.
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Affiliation(s)
- Leigh Tooth
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
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