Association of Physical Functioning with Same-Hospital Readmission After Stroke

Bohannon, Richard W.; Lee, Nora

doi:10.1097/00002060-200406000-00005

Cited by 32 publications

(33 citation statements)

References 13 publications

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“…Most likely, this is because the patients discharged to the nursing homes had more disabling strokes. As in our hospital based study, severe strokes and increased functional disability have consistently been shown to predict readmission in administrative databases [8,22]. Another plausible explanation is that caregivers at home and in acute care-rehabilitation settings are able to pick up problems earlier and can address issues before they become serious to require hospitalization.…”

Section: Discussionsupporting

confidence: 52%

Why do ischemic stroke and transient ischemic attack patients get readmitted?

Bhattacharya¹,

Khanal²,

Madhavan³

2011

Journal of the Neurological Sciences

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Section: Discussionsupporting

confidence: 52%

Why do ischemic stroke and transient ischemic attack patients get readmitted?

Bhattacharya¹,

Khanal²,

Madhavan³

2011

Journal of the Neurological Sciences

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“…7,44 In the acute care setting, for example, Coleman et al 7 reported that including functional status based on survey data improved the prediction of readmissions compared with the use of administrative data alone in Medicare beneficiaries. Bohannon and Lee 6 also found that in patients with acute ischemic stroke, functional measures were predictive of readmissions independent of other demographic and clinical factors. In the context of inpatient rehabilitation, studies have separately evaluated read-missions that occurred during CIIRP and post-CIIRP discharge.…”

Section: Discussionmentioning

confidence: 91%

Functional Status Impairment Is Associated With Unplanned Readmissions

Hoyer

Needham

Miller

et al. 2013

Archives of Physical Medicine and Rehabilitation

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Objective: To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. Design: Retrospective cohort study. Setting: Academic hospital-based CIIRP. Participants: Consecutive patients (NZ1515) admitted to a CIIRP between January 2009 and June 2012. Interventions: Patients’ functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis. Main Outcome Measures: Readmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome. Results: Among the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AORZ2.6; 95% CI, 1.9e3.7; P<.001 and AORZ1.7; 95% CI, 1.2e2.4; PZ.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AORZ3.5; 95% CI, 2.2e5.8; P<.001 and AORZ2.1; 95% CI, 1.3e3.5l PZ.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AORZ1.6; 95% CI, 1.0e2.4; PZ.047 and AORZ1.3; 95% CI, 0.8e1.9; PZ.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. Conclusions: Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.

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“…Over time, this results in a loss of the recovered gains achieved from rehabilitation, and sedentary behavior worsens physical function. This may have some relationship to the aforementioned high rates of rehospitalization in some populations [30,31]. Additionally, as a person with a disability remains inactive, physical deconditioning occurs that worsens and increases the risk of secondary conditions.…”

Section: Difficult Transition From Patient To Participantmentioning

confidence: 99%

Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

Rimmer

Lai

2015

Disability and Rehabilitation

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Purpose: This paper describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis referred to as the Transformative Exercise Framework. Background: The period directly after rehabilitation is a critical juncture where many individuals return to life with high rates of sedentary behavior. After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe and effective. Methods: Narrative review. Results: The Transformative Exercise Framework supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The four focus areas – Rehabilitation, Condition-specific Exercise, Fitness and Lifetime Physical Activity – emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned. Conclusion: The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore–improve–prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline.Implications for RehabilitationPatients discharged from rehabilitation should be transformed into participants in lifelong physical activity through a continuum of health services, which we refer to as Transformative Exercise.Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to improve the function of underperforming systems, which inhibit community and/or lifelong physical activity participation.The Transformative Exercise Framework can be used by a therapist or exercise trainer to design a program that maximizes performance and time and is based on a specific process for identifying short and long term goals.

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Association of Physical Functioning with Same-Hospital Readmission After Stroke

Abstract: The importance of physical functioning goes beyond rehabilitation. It is a potentially modifiable variable with implications for readmission.

Cited by 32 publications

References 13 publications

Why do ischemic stroke and transient ischemic attack patients get readmitted?

Why do ischemic stroke and transient ischemic attack patients get readmitted?

Functional Status Impairment Is Associated With Unplanned Readmissions

Framing new pathways in transformative exercise for individuals with existing and newly acquired disability

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