Abstract WP320: Patient-centered Predictors of Rehabilitation Care after Acute Stroke
INTRODUCTION: Rehabilitation plays a key role in helping stroke survivors return to the community. Assessment of rehabilitation needs in the acute hospital is widely acknowledged as important, but has not been well defined. We therefore conducted a pilot study to examine the feasibility of completing a standardized assessment of stroke patient rehabilitation needs in acute hospitals and determine the relationship with discharge destination.
Methods: Twenty-two hospitals within the Northeast Cerebrovascular Consortium (NECC) (consisting of CT, MA, ME, NH, NJ, NY, RI, and VT) participated in a pilot program to collect specific clinical measures believed to predict rehabilitation needs: sociodemographics, pre-morbid disability (modified Rankin Scale, mRS), level of ADL assistance needed (Barthel Index), cognition (Short Portable Mental Status Questionnaire) and caregiver availability. Data were collected as an extension of the American Heart Association’s Get With the Guidelines-Stroke program on 836 patients in 2010-11, of whom 630 (80%) had sufficient data recorded for further analysis. The Barthel index was divided into quintiles for analysis.
Results: In multivariable analysis, only the Barthel Index was independently associated with return home vs. discharge to institution-based rehabilitation post-stroke (p<0.001; c=0.902), with 92% of patients with Barthel Index of 85 or higher returning home, and 91% of patients with Barthel Index of 20 or below receiving institution-based rehabilitation. In multivariable analysis comparing patients referred to Inpatient Rehabilitation Facilities (IRF) versus Skilled Nursing Facilities (SNF), no association was seen with the Barthel Index, but patients with pre-morbid disability (mRS=2-5) were more likely to receive SNF care (OR=2.86, 95%CI=1.66-4.93) than those without pre-morbid disability (mRS=0-1).
Discussion: We conclude that formal assessment of rehabilitation needs of stroke survivors in the acute care setting was practicable. The Barthel Index was highly predictive of receiving home vs. SNF/IRF rehabilitation care, and among those patients not returning directly home, pre-morbid mRS was predictive of receiving IRF versus SNF care.
- © 2012 by American Heart Association, Inc.