Article

OBJECTIVE: To investigate whether there were variations in practice in selection
for rehabilitation after stroke, after adjustment for case mix. DESIGN:
Prospective multicenter audit. SETTING: Seven acute stroke units in metropolitan
and regional Victoria, Australia. Consecutive acute stroke
admissions (N=616). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mobility Scale
for Acute Stroke Score and Modified Barthel Index (MBI) scores for continence at
day 3 poststroke, discharge destination from the acute hospital. RESULTS: Data
were analyzed for 616 stroke survivors. Considerable variability in the
percentage of cases accessing inpatient rehabilitation was observed in severe
stroke (27%-67%) and mild stroke (27%-73%). To assess adjustment for case mix, a
multinomial logistic regression was conducted with the outcome variable being
discharge destination (home, rehabilitation, or nursing home), and the predictors
being Mobility Scale for Acute Stroke Score, MBI continence scores, age, and
social situation. The overall amount of variability explained in discharge
destination by the predictors was 63% (Nagelkerke pseudo R(2)). The regression
analysis was repeated, adding unit code as a predictor. Unit code was a
significant contributor to the model (P<.01). CONCLUSION: The results of the
study indicate that, after adjusting for case mix, there may be variations in
practice in selection for rehabilitation leading to inequities of access.

Langue : ANGLAIS