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Use of a standardized assessment to predict rehabilitation care after acute stroke.

Publication ,  Journal Article
Stein, J; Bettger, JP; Sicklick, A; Hedeman, R; Magdon-Ismail, Z; Schwamm, LH
Published in: Arch Phys Med Rehabil
February 2015

OBJECTIVE: To pilot a program of formal assessment of rehabilitation needs and predictors of referral to rehabilitation. DESIGN: A prospective pilot project to collect standardized measures of stroke severity and function: National Institutes of Health Stroke Scale, premorbid modified Rankin scale, Short Portable Mental Status Questionnaire, and Barthel Index (BI). These were collected in addition to routine data in the Get With The Guidelines-Stroke registry. Logistic regression was used to examine predictors of referral to any institution-based rehabilitation versus discharge home and referral to an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF). SETTING: Twenty-two hospitals within the Northeast Cerebrovascular Consortium (located in the northeastern United States). PARTICIPANTS: Data were collected on individuals with acute ischemic and hemorrhagic stroke (N=736). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge disposition location. RESULTS: The BI score was recorded in 736 (81%) patients. In multivariable analyses, a higher BI score (85-100) was the only factor associated with return home versus need for institution-based rehabilitation (P<.001). Among patients discharged to IRF versus SNF, discharge to IRF was less likely in older patients (odds ratio [OR], .96; confidence interval [CI], .94-.98; P<.001) and in those with prestroke disability (modified Rankin scale score, 2-5) (OR, .47; CI, .28-.78; P=.004) and more likely in those with moderate-severe (BI score, 25-40; OR, 3.26; CI, 1.45-7.30; P=.004) or moderate (BI score, 45-60; OR, 2.47; CI, 1.17-5.21; P=.018) activities of daily living (ADL) impairment. CONCLUSIONS: Formal standardized assessment of rehabilitation needs was feasible in this pilot project. Patients' sociodemographic characteristics, premorbid function, and ADL impairment discriminated better between discharge home and institution-based rehabilitation than between IRF and SNF. Selection of IRF versus SNF appears to be influenced either by unmeasured clinical characteristics of individuals with stroke or by nonclinical factors, such as cost, geography, referral relationships, or IRF availability.

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Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

February 2015

Volume

96

Issue

2

Start / End Page

210 / 217

Location

United States

Related Subject Headings

  • Stroke Rehabilitation
  • Skilled Nursing Facilities
  • Severity of Illness Index
  • Rehabilitation Centers
  • Rehabilitation
  • Prospective Studies
  • Pilot Projects
  • Patient Discharge
  • Middle Aged
  • Mental Health
 

Citation

APA
Chicago
ICMJE
MLA
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Stein, J., Bettger, J. P., Sicklick, A., Hedeman, R., Magdon-Ismail, Z., & Schwamm, L. H. (2015). Use of a standardized assessment to predict rehabilitation care after acute stroke. Arch Phys Med Rehabil, 96(2), 210–217. https://doi.org/10.1016/j.apmr.2014.07.403
Stein, Joel, Janet Prvu Bettger, Alyse Sicklick, Robin Hedeman, Zainab Magdon-Ismail, and Lee H. Schwamm. “Use of a standardized assessment to predict rehabilitation care after acute stroke.Arch Phys Med Rehabil 96, no. 2 (February 2015): 210–17. https://doi.org/10.1016/j.apmr.2014.07.403.
Stein J, Bettger JP, Sicklick A, Hedeman R, Magdon-Ismail Z, Schwamm LH. Use of a standardized assessment to predict rehabilitation care after acute stroke. Arch Phys Med Rehabil. 2015 Feb;96(2):210–7.
Stein, Joel, et al. “Use of a standardized assessment to predict rehabilitation care after acute stroke.Arch Phys Med Rehabil, vol. 96, no. 2, Feb. 2015, pp. 210–17. Pubmed, doi:10.1016/j.apmr.2014.07.403.
Stein J, Bettger JP, Sicklick A, Hedeman R, Magdon-Ismail Z, Schwamm LH. Use of a standardized assessment to predict rehabilitation care after acute stroke. Arch Phys Med Rehabil. 2015 Feb;96(2):210–217.
Journal cover image

Published In

Arch Phys Med Rehabil

DOI

EISSN

1532-821X

Publication Date

February 2015

Volume

96

Issue

2

Start / End Page

210 / 217

Location

United States

Related Subject Headings

  • Stroke Rehabilitation
  • Skilled Nursing Facilities
  • Severity of Illness Index
  • Rehabilitation Centers
  • Rehabilitation
  • Prospective Studies
  • Pilot Projects
  • Patient Discharge
  • Middle Aged
  • Mental Health