Timing of Initiation of Rehabilitation After Stroke
Abstract
Maulden SA, Gassaway J, Horn SD, Smout RJ, DeJong G. Timing of initiation of rehabilitation after stroke.
Objective
To study associations between days from stroke symptom onset to rehabilitation admission and rehabilitation outcomes, controlling for a variety of confounding variables.
Design
Observational cohort study of 200 consecutive poststroke rehabilitation patients in each of 6 inpatient rehabilitation facilities.
Setting
Six U.S. inpatient rehabilitation hospitals.
Participants
Patients (N=969) with moderate or severe strokes who had days from stroke symptom onset to rehabilitation admission recorded in their medical records.
Interventions
Not applicable.
Main Outcome Measures
Discharge total FIM, discharge motor FIM, discharge activities of daily living (ADL) FIM, and discharge mobility FIM scores, as well as rehabilitation length of stay (LOS).
Results
Fewer days from stroke symptom onset to rehabilitation admission was associated significantly with better functional outcomes: higher total, motor, mobility, and ADL discharge FIM scores, controlling for confounding variables. For severely impaired patients with stroke in case-mix groups (CMGs) 108–114, the relation was strongest, with F statistics greater than 24.1 for each functional outcome. For patients with moderately severe stroke in CMGs 104–107, fewer days from stroke symptom onset to rehabilitation admission was associated significantly with shorter rehabilitation LOS.
Conclusions
Fewer days from stroke symptom onset to rehabilitation admission is associated with better functional outcomes at discharge and shorter LOS.
eDepartment of Rehabilitation Medicine, Georgetown University, Washington, DC
Reprint requests to Susan D. Horn, PhD, Institute for Clinical Outcomes Research, 699 E South Temple, Ste 100, Salt Lake City, UT 84102-1282
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133B990005) and the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032). The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT