Trade-Offs between Effectiveness and Efficiency in Stroke Rehabilitation

Abstract

There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.

Rehabilitation impact indices and their independent predictors: a systematic review

“…Greater neurological impairment 13 --(5) urinary incontinence, 14 23 (6) myocardial infarction 1 (7) longer 'stroke onset to admission into rehabilitation unit' time, 14 26 (8) longer 'admission to unit to start of rehabilitation' time, 14 (9) poor adherence to clinical practice guidelines, 17 (10) territory of stroke, 17 (11) orthogeriatric setting (as compared with a two-step model of orthopaedic surgery followed by transfer to a geriatric rehabilitation facility), 18 (12) (20) infarct (vs haemorrhage) stroke 26 and (21) shorter length of stay (LOS). 23 26 The independent predictors of REs/MRFS/RFG were supported by stroke (9 studies), post-hip-fracture arthroplasty (5 studies), elderly (1 study) and gait disorders (1 study).…”

“…However, if the first functional measurement was performed many days after admission or the last functional assessment was performed many days before date of discharge, REy and RREy may be spuriously high if LOS was used in the denominator. Hence, it may be more accurate to use the number of days between the date of first and last functional measurement as the denominator for REy instead of LOS, as conducted by Koh et al 26 In fact, it was because Koh et al used time between first and last functional assessment in their study that they were able to demonstrate that LOS was an independent predictor of REy and not the result of statistical singularity arising from LOS being the denominator of REy.…”

“…Higher pre-rehabilitation functional status 26 (4) non-haemorrhagic (vs haemorrhagic) stroke, 26 28 (5) depression, 34 42 54 (6) cognitive impairment, 7 26 54 (7) poorer balance, 30 (8) heterotopic ossification on triple-phase bone scan (vs none), 35 (9) non-traumatic (vs traumatic) spinal cord injury, 38 (10) encephalitis (vs traumatic brain injury or stroke), 39 (11) longer LOS, 15 26 (12) direct admission from emergency ward (vs indirect admission via general medical ward), 41 (13) not receiving radiation therapy during rehabilitation (vs receiving) in patients with brain tumour, 45 (14) recurrent (vs first diagnosis) in patients with brain tumour, 45 (15) greater comorbidity burden, 47 71 (16) . They proposed that the highest possible functional status should not be the maximum score of the functional assessment tool used but the premorbid functional score instead.…”

Factors associated with the recovery of activities of daily living after hospitalization for acute medical illness: a prospective cohort study

“…Previous studies have reported the factors related to prognosis of ADL in stroke and post-hip-fracture patients include: old age4, 5 ) , cognitive impairment4, 6 ) , and lower pre-rehabilitation functional status6,7,8 ) . Few reports have focused on the factors related to prognosis of ADL of elderly patients with acute medical illness9 ) .…”

Issues in rehabilitation of patients after stroke in the out-patient setting

“…Эти со стояния имеют неблагоприятные последствия: снижают качество жизни пациента и увеличивают нагрузку на членов его семьи, увеличивают расходы системы здравоохранения [7]. Сообщалось, что различные факторы способствуют неблагоприятному прогнозу в отношении функциональ-ной активности пациентов после инсульта, в их числе возраст [8][9][10], ухудшение физических функций до реаби-литации [11], когнитивные нарушения [8] и недержание мочи [9]. Через 12 месяцев после инсульта около 28% пациентов остаются зависимыми в таких сферах, как оде-вание, использование туалета и передвижение по поме-щению [12].…”