Post stroke disposition from a Geriatric-Rehabilitative Stroke Care Area: an Italian experience

Abstract

A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6), after stroke functional status (mRankin≥3), poor pre-stroke functional level (mRankin≥3) and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled longterm ward of older patients with pre-stroke disability seemed positive on an economic ground but further studies are mandatory to understand the consequences in terms of functional recovery and social costs. Key words: post-stroke disposition, disability, age, multi-professional assessment.Acknowledgements: the authors thank Ms Claudia Neri for her competent assistance in research, data extraction and data checking. A grateful thank is extended to the whole staff of modern matron, nurses, nurse assistants and physiotherapists for their dedicated efforts and competent care of stroke patients.Contributions: MM, study concept and design, drafting/revising manuscript for content, including medical writing for content, analysis and interpretation data, study supervision and coordination, manuscript final approval; SM, drafting/revising manuscript for content, acquisition of data, writing manuscript; PFC, drafting/revising manuscript for content, acquisition of data; AC, drafting/revising manuscript for content, acquisition of data; PM, statistical analysis, analysis and int...