Selection for Inpatient Rehabilitation After Acute Stroke: A Systematic Review of the Literature

Hakkennes, Sharon; Brock, Kim; Hill, Keith

doi:10.1016/j.apmr.2011.07.189

Cited by 85 publications

(107 citation statements)

References 86 publications

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“…70,269,270 Certain factors such as older age, impaired cognition, lower functional level after stroke, and urinary incontinence are predictors of the need for inpatient rehabilitation care. 54,271 The presence of neglect syndrome can predict a longer rehabilitation stay and lower functional status at discharge. 272 Among patients with less neurological impairment, assessment of balance ability with standardized measures such as the Berg Balance Scale or the Postural Assessment Scale for Stroke can help determine the risk of fall and need for inpatient rehabilitation rather than discharge home with outpatient services [273][274][275] (The Prevention of Falls section provides more information).…”

Section: Assessing Overall Rehabilitation Needsmentioning

confidence: 99%

“…53 Age, cognition, functional level after stroke, and to a lesser extent continence have shown consistent associations with poststroke outcomes, and stroke severity is associated with acute discharge disposition, final discharge disposition, and functional level. 54 In recent years, lengths of stay in IRFs have decreased significantly, but in survivors with mild to moderate stroke, patient satisfaction does not appear to be diminished, and recovery actually may be faster. 55 In the United States, data after the initiation of prospective payment for rehabilitation in 2002 suggest that discharges from IRFs to institutional settings have increased.…”

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confidence: 99%

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Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,087

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Assessing Overall Rehabilitation Needsmentioning

confidence: 99%

mentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,087

840

View full text Add to dashboard Cite

show abstract

“…According to literature, [4][5][6][7][9][10][11][12][13]19 the NIH-SS score on admission highly correlated to hospital disposition (P<0.0001). Among patients discharged home 76% had a NIH-SS score ≤5, 22% had NIH-SS score ≥6-13 and only 2% had a score >13.…”

Section: Resultsmentioning

confidence: 99%

“…The limited number of rehabilitative beds, the longer waiting time and the availability of a low intensive physiotherapy program in long-term wards might have lead physiatrists to select patients with better pre-stroke conditions and younger age in whom a valid functional recovery was more likely. 10,13 That choice had important economic effects. The overall in-hospital LOS was of 30.5±17.9 days for patients discharged to long-term ward and of 43.5±22.9 days for those admitted to rehabilitation ward.…”

Section: Discussionmentioning

confidence: 99%

“…12 In a recent systematic review Hakkennes highlighted the most important indicators of disposition from a stroke unit [age, cognitive status, National Institute of Health Stroke Scale (NIH-SS) score, after stroke functional status and comorbidity] and the indicators of admission to rehabilitation (after stroke impairment, prestroke functional level and cognitive status). 13 Nevertheless absolute selection criteria for rehabilitation admission remain not available. 14 In 2010, according to the Emilia Romagna regional stroke care program, a new stroke area opened in the Bentivoglio Hospital, which offers in-patient cares to the 150,000 inhabitants in the northern suburban province of Bologna.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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...

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Association Between Race and Receipt of Home- and Community-Based Rehabilitation After Traumatic Brain Injury Among Older Medicare Beneficiaries

Albrecht

Kumar

2023

JAMA Surg

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ImportanceNon-Hispanic Black (hereafter Black) patients with traumatic brain injury (TBI) experience worse long-term outcomes and residual disability compared with non-Hispanic White (hereafter White) patients. Receipt of appropriate rehabilitation can improve function among older adults after TBI.ObjectiveTo assess the association between race and receipt of home- and community-based rehabilitation among a nationally representative sample of older Medicare beneficiaries with TBI.Design, Setting, and ParticipantsThis cohort study analyzed a random sample of Medicare administrative claims data for community-dwelling Medicare beneficiaries aged 65 years or older who were hospitalized with a primary diagnosis of TBI and discharged alive to a nonhospice setting from 2010 through 2018. Claims data for Medicare beneficiaries of other races and ethnicities were excluded due to the small sample sizes within each category. Data were analyzed January 21 to August 30, 2022.ExposuresBlack or White race.Main Outcomes and MeasuresMonthly use rates of home-based or outpatient rehabilitation were calculated over the 6 months after discharge from the hospital. The denominator for rate calculations accounted for variation in length of hospital and rehabilitation facility stays and loss to follow-up due to death. Rates over time were modeled using generalized estimating equations, controlling for TBI acuity, demographic characteristics, comorbidities, and socioeconomic factors.ResultsAmong 19 026 Medicare beneficiaries (mean [SD] age, 81.6 [8.1] years; 10 781 women [56.7%]; and 994 Black beneficiaries [5.2%] and 18 032 White beneficiaries [94.8%]), receipt of 1 or more home health rehabilitation visits did not differ by race (Black vs White, 47.4% vs 46.2%; P = .46), but Black beneficiaries were less likely to receive 1 or more outpatient rehabilitation visits compared with White beneficiaries (3.4% vs 7.1%; P &lt; .001). In fully adjusted regression models, Black beneficiaries received less outpatient therapy over the 6 months after TBI (rate ratio, 0.60; 95% CI, 0.38-0.93). However, Black beneficiaries received more home health rehabilitation therapy over the 6 months after TBI than White beneficiaries (rate ratio, 1.15; 95% CI, 1.00-1.32).Conclusions and RelevanceThis cohort study found relative shifts in rehabilitation use, with markedly lower outpatient therapy use and modestly higher home health care use among Black patients compared with White patients with TBI. These disparities may contribute to reduced functional recovery and residual disability among racial and ethnic minority groups. Additional studies are needed to assess the association between the amount of outpatient rehabilitation care and functional recovery after TBI in socioeconomically disadvantaged populations.

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Selection for Inpatient Rehabilitation After Acute Stroke: A Systematic Review of the Literature

Cited by 85 publications

References 86 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

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

Association Between Race and Receipt of Home- and Community-Based Rehabilitation After Traumatic Brain Injury Among Older Medicare Beneficiaries

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