Poster 28: Post‐Stroke Rehabilitation: Factors Predicting Discharge to Acute versus Subacute Rehabilitation Facilities

Rakesh, Neal; Boiarsky, Daniel; Athar, Ammar; Hinds, Shaliesha; Stein, Joel

doi:10.1016/j.pmrj.2018.08.067

Cited by 9 publications

(11 citation statements)

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“…The discharge to institution cohort had a larger percentage of individuals with physical and mental health deficits than those who were discharged home. Consistent with previous research investigating predictors for discharge destination, marital status 25,31 and the presence of compromised physical health (eg, mobility [28][29][30] ) were significant predictors of discharge destination within a logistic regression model. Individuals were more likely to be discharged home if they were married or without functional physical deficits.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies have examined many factors that predict discharge destination. Predictors of discharge destination in general medical and rehabilitation populations have included, but are not limited to, severity of illness, 24 functional status, [25][26][27][28] mobility, [28][29][30] cognitive status, 25 length of stay, 29 depression, 25 and sociodemographic factors such as age, 27,28 ethnicity, 25 number of coresident household numbers, 27 and marital status. 25,31 In an age-and Elixhauser comorbidityematched sample cohort with COVID-19, 88.2% had physical health deficits, 72.5% had mental health deficits, and 17.6% experienced sensory deficits.…”

Section: Discussionmentioning

confidence: 99%

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Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Roberts

Wertheimer

Park³

et al. 2021

Archives of Physical Medicine and Rehabilitation

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Objective The objectives of this study were to identify functional limitations in COVID-19 patients admitted to acute care hospitals, to evaluate functional limitations by demographic, medical and encounter characteristics, and to examine functional limitations in relation to discharge destination. Design and Setting This is a cross sectional, retrospective study of adult patients with COVID-19 who were discharged from two different types of hospitals (academic medical center and a community hospital) within one healthcare system between January 1 and April 30, 2020. Participants Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new onset positive test for SARS-CoV-2. A total of 273 cases were identified, which included 230 cases that were discharged alive and 43 patients who expired and were excluded from the study sample. Interventions Not applicable Main Outcome Measures Functional limitations in COVID-19 patients in acute care hospitals and the predictors for discharge disposition. Results A total of 230 records were analyzed including demographic, encounter, medical, and functional variables. In a propensity-score matched cohort based on age and comorbidity, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs. 25.5%, p<.001) and mental health (49.0% vs. 23.5%, p=.006) deficits than patients discharged home. Marital status (OR 3.17, p=.011) and physical function deficits (OR 3.63, p=0.025) were associated with an increase odds ratio of discharge to an institution. Conclusions This research highlights that functional status is a strong predictor for discharge destination to an institution for COVID-19 patients. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the healthcare system for these vulnerable patients. The challenges of adjusting the role of rehabilitation providers and systems during the pandemic needs further exploration. Moreover, additional research is needed to look more closely at the many facets and timing of functional status needs, to shed light in utilization of interdisciplinary rehabilitation services, and to guide providers and healthcare systems in facilitating optimal recovery and patient outcomes.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Roberts

Wertheimer

Park³

et al. 2021

Archives of Physical Medicine and Rehabilitation

View full text Add to dashboard Cite

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“…Multiple lineal regression models were performed on significant variables from the univariate analyses. Given the sample size limitation, a maximum of 5 variables were used per model (as in similar previous research [ 28 ] ). Nine significant models emerged as presented in Table 7 , highest R 2 values were obtained in model #2 adjusted R 2 = 0.2442 (R 2 = 26.19) with side of paresis and T-FIM-Adm contributing significantly.…”

Section: Resultsmentioning

confidence: 99%

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

et al. 2020

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Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission. A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated ( P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models. No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) ( P < .001) and hemiparesis ( P = .0108) (adjusted R 2 = 0.24), 2) cognitive FIM ( P = .002) and severity ( P = .001) (adjusted R 2 = 0.22), and 3) home accessibility ( P = .043) and hemiparesis ( P = 0.032) (adjusted R 2 = 0.19). Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset. Socioeconomic situation was found moderately correlated with total FIM (r = −0.32, P < .0001). When stratifying the patients’ socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group ( P < .001); also significant differences were found between mild and severe groups ( P < .001). A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients. Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.

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“…[ 10 ] Post-stroke aphasia considerably impacts personal and public life in patients, and gravely increases healthcare expenditures. [ 1 , 11 , 12 ] Therefore, early detection of stroke-induced aphasia and prompt intervention are extremely important. Studies have reported that intensive language therapy administered at the early stage may improve neurological function and increase the language recovery rate.…”

Section: Introductionmentioning

confidence: 99%

Development and application of a Chinese Version of the Language Screening Test (CLAST) in post-stroke patients

et al. 2020

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Aphasia shows high incidence in stroke patients and seriously impairs language comprehension, verbal communication, and social activities. Therefore, screening aphasic patients during the acute phase of stroke is crucial for language recovery and rehabilitation. The present study developed a Chinese version of the Language Screening Test (CLAST) and validated it in post-stroke patients. The CLAST was adapted from the Language Screening Test developed by Constance et al to incorporate Chinese cultural and linguistic specificities, and administered to 207 acute stroke patients and 89 stabilized aphasic or non-aphasic patients. Based on the Western Aphasia Battery (WAB) test, its reliability and validity were assessed. A cut-off for the CLAST in Chinese patients was determined by ROC curve analysis. The CLAST comprised 5 subtests and 15 items, including 2 subscores, namely expression (8 points, assessing naming, repetition, and automatic speech) and receptive (7 points maximum, evaluating picture recognition, and verbal instructions) indexes. Analysis of the alternate-form reliability of the questionnaire showed a retest correlation coefficient of 0.945 ( P < .001). Intraclass correlation coefficients of three rating teams were >0.98 ( P < .001). Internal consistency analysis showed a Cronbach's alpha coefficient of 0.909 ( P < .001). The non-aphasia group showed higher scores than the aphasia group (14.2 ± 1.3 vs 10.6 ± 3.8) ( P < .01). The questionnaire showed good construct validity by factor analysis. ROC curve analysis showed high sensitivity and specificity for the CLAST, with a cut-off of 13.5. The CLAST is suitable for Chinese post-stroke patients during the acute phase, with high reliability, validity, sensitivity, and specificity.

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Poster 28: Post‐Stroke Rehabilitation: Factors Predicting Discharge to Acute versus Subacute Rehabilitation Facilities

Cited by 9 publications

References 0 publications

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

Development and application of a Chinese Version of the Language Screening Test (CLAST) in post-stroke patients

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