Article

OBJECTIVES: To study the degree to which initial physical grades and cognitive
stages of independence assessed by physical medicine and rehabilitation (PM&R)
staff early after hospitalization for acute stroke relate to the decision to
either provide rehabilitation in consultation or admission to a specialized
rehabilitation unit (SRU) for comprehensive, high-intensity, multidisciplinary
rehabilitation. DESIGN: An observational study.
SETTING: Early rehabilitation
assessment by PM&R staff during patients' acute hospitalization for stroke in 112
Veterans Affairs facilities. PATIENTS: The sample included 8,783 veterans who
were assessed by PM&R staff. METHODS: Shortly after hospital admission,
functional status was determined according to 7 physical grades and 7 cognitive
stages of increasing independence. Patients' physical grades and cognitive stages
ranged at initial PM&R assessment from the lowest and most dependent "I" through
intermediate "II, III, IV, V, or VI," and ended with the highest at total
independence "VII." To assess the statistically independent effects of physical
grade and cognitive stage, a multivariable generalized estimating equation was
applied to account for within Veterans Affairs facilities correlation and to
adjust for demographics, stroke type, comorbidities, clinical events before PM&R
assessment, and facility-related factors. MAIN OUTCOME MEASUREMENTS: The decision
to admit patients to an SRU for comprehensive rehabilitation. RESULTS: Only 11.2%
of those patients assessed after stroke were admitted to an SRU after the acute
management phase. After statistical adjustment, patients at the lowest physical
grade (I) of independence had a 9-fold increased odds of admission to an SRU
compared with those at the highest combined physical grades VI/VII (adjusted odds
ratio 9.15, 95% confidence interval 4.31-19.39). In contrast, patients at
intermediate cognitive stages of independence were the most likely to be admitted
to an SRU. The presence of an SRU within the treating Veterans Affairs facility
was strongly related to admission. CONCLUSIONS: Patients' physical grades and
cognitive stages assessed early after stroke are strong determinants of referral
for comprehensive rehabilitation.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS