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

Abstract

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.

Combined Functional Assessment for Predicting Clinical Outcomes in Stroke Patients After Post-acute Care: A Retrospective Multi-Center Cohort in Central Taiwan

“…As improved MRS, ADLs, IADLs, BBS, and MMSE can all reduce the risk of readmission, a routine plan with a continuous rehabilitation process is needed before discharge. Many factors influence subacute rehabilitation LOS, including stroke severity measured with the National Institute of Health Stroke Scale (NIHSS), ability to perform ADLs, or admission Functional Independence Measure (FIM) score (Garcia-Rudolph et al, 2020). This study showed that in the general hospital setting, CVA patients with higher baseline MRS, lower ADLs/IADLs, poorer FOIS, and MNA had longer LOS in PAC units.…”

Risk factor identification and prediction models for prolonged length of stay in hospital after acute ischemic stroke using artificial neural networks

“…This is in concordance with current evidence that patients with a prolonged LOS exhibited a 9.3-fold higher risk of unfavorable AIS outcomes at discharge than their non-prolonged LOS counterparts. Patients with a severe disability after AIS usually need to be hospitalized for a more extended period because they may require more treatments and rehabilitation support ( 41 – 43 ). Although it is challenging to accurately predict LOS because of the multifactorial nature of stroke, its prediction is of paramount clinical relevance.…”

Anti-Epileptic Medication Exposure Influences Functional Status in New Zealand Stroke Patients: A Retrospective Population-Level Study

“…Consequently, we observed no difference in LOS between AED-exposed and -unexposed patients, suggesting that poorer functional status in AED-exposed patients was not related to greater initial stroke severity. Although we recognise that other factors besides stroke severity contribute to LOS, including socioeconomic status [ 24 ], LOS remains a reliable predictor of and reasonable proxy for stroke severity [ 19 , 25 ]. As mentioned, stroke location was unknown for this cohort, and it is possible that the higher incidence of cortical infarcts in patients who developed post-stroke epilepsy led to more profound motor deficits and ultimately greater disability in performing ADLs.…”