Early Inpatient Rehabilitation Admission and Stroke Patient Outcomes

Wang, Hua; Camicia, Michelle; DiVita, Margaret A.; Mix, Jacqueline; Niewczyk, Paulette

doi:10.1097/phm.0000000000000226

Cited by 22 publications

(22 citation statements)

References 11 publications

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Section: Discussionmentioning

confidence: 99%

“…However, after suffering IS, patients are at high risk for permanent disability, but evidence shows that rehabilitation improves functional outcomes, particularly when started early. 2,33,34 Lower utilization of postacute care has also been demonstrated in the uninsured after trauma and sepsis. 9,35 Unfortunately, postacute care is expensive, and acceptance into such programs is highly dependent on ability to pay and insurance authorizations, which likely explains the differences observed in this study.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke

Medford‐Davis

Fonarow

Bhatt

et al. 2016

JAHA

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BackgroundInsurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government‐sponsored insurance had worse quality of care or in‐hospital outcomes in acute ischemic stroke.Methods and ResultsMultivariable logistic regressions with generalized estimating equations stratified by age under or at least 65 years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in‐hospital mortality and postdischarge destination. We included 589 320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines‐Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65 years, OR 1.33 [95% CI 1.22‐1.45]; ≥65 years OR 1.54 [95% CI 1.34‐1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95% CI 0.6‐0.67]; ≥65 OR 0.56 [95% CI 0.5‐0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65 years OR 2.08 [CI 1.96‐2.2]; OR 2.01 [95% CI 1.91‐2.13]; ≥65 years OR 1.1 [95% CI 1.07‐1.13]; OR 1.41 [95% CI 1.35‐1.46]).ConclusionsPreventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and in‐hospital mortality differ by patient insurance status.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke

Medford‐Davis

Fonarow

Bhatt

et al. 2016

JAHA

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“…3 Differences in FIM gain based on stroke severity have been reported previously in the literature. [4][5][6] In Canada, length of stay (LOS) in rehabilitation varies by stroke severity, with a median LOS of 31 days. 3 In some studies, mild stroke patients experienced the shortest LOS, and severe stroke patients experienced the longest LOS.…”

Section: Introductionmentioning

confidence: 99%

“…Patients who are transferred sooner to a rehabilitation program may have improved functional outcomes. [4][5][6]8,[10][11][12][13][14][15][16][17] These outcomes have most often been measured by discharge FIM scores (motor and cognitive scores), Barthel Index (BI) scores, modified Rankin Scale (mRS) scores, and/or Rivermead Mobility Index (RMI) scores. Moderate and severe stroke patients who are admitted earlier to a rehabilitation unit have been shown to have larger motor and cognitive function gains.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

Tanlaka

King‐Shier

Green

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background:We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.Methods:Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.Results:The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10–9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10–9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10–9, partial η2 0.022) and LOS (p = 1.1 × 10–19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.Conclusion:Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

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“…Rehabilitation after stroke is crucial, especially during the golden period of functional recovery (2,3). However, poststroke hemiplegic shoulder pain (HSP) is a common complication that often hampers rehabilitation (4).…”

mentioning

confidence: 99%

Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study

Huang¹,

Chang²,

Liou³

et al. 2017

J Rehabil Med

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Objective: To investigate the effects of Kinesio taping for stroke patients with hemiplegic shoulder pain. Design: Double-blind, placebo-controlled clinical trial. Subjects: Twenty-one stroke patients with hemiplegic shoulder pain within 6 months of stroke onset in the rehabilitation ward of a medical university hospital in Taiwan. Methods: A 3-week intervention involving a conventional rehabilitation protocol and therapeutic Kinesio taping was conducted with an experimental group of 11 stroke patients. A control group of 10 stroke patients underwent an identical conventional rehabilitation programme and sham Kinesio taping on the hemiplegic shoulder. Numerical rating scale scores, Shoulder Pain and Disability Index, ultrasound findings and pain-free passive range of motion of the affected shoulder, were evaluated before and after the intervention. Mann-Whitney test was used to compare within-group continuous variables before and after the intervention. Wilcoxon signed-rank test was used to analyse the differences and changes in values between study and control groups. Results: There was no statistical difference in demographic variables between the 2 groups. Both groups showed improvement in passive range of motion of the shoulder, (mean numerical rating scale 2.36 (standard deviation (SD) 1.03)), and mean Shoulder Pain and Disability Index (16.64 (SD 2.62)) after the intervention (p < 0.001); however, no significant between-group differences were observed in the numerical rating scale score, pain-free passive ROM, and ultrasound findings for the shoulder after 3 weeks of treatment. Concerning the variables changes, the therapeutic Kinesio taping group showed more improvement in the numerical rating scale

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Early Inpatient Rehabilitation Admission and Stroke Patient Outcomes

Abstract: Earlier IRF admission was beneficial among severely and moderately impaired patients. IRF admission within 7 days is recommended for stroke patients who achieved medical stability.

Cited by 22 publications

References 11 publications

Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke

Impact of Insurance Status on Outcomes and Use of Rehabilitation Services in Acute Ischemic Stroke: Findings From Get With The Guidelines‐Stroke

Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study

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