Article

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS