Abstract
Objective
Assess the association of time to initiation of acute rehabilitation therapy with
disability after intracerebral hemorrhage (ICH) and identify predictors of time to
initiation of rehabilitation therapy.
Design
Retrospective data analysis of prospectively collected data from an ongoing observational
cohort study.
Setting
Large comprehensive stroke center in a metropolitan area.
Participants
Adults with ICH consecutively admitted (n=203).
Interventions
Not applicable.
Main Outcome Measures
Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined
as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy
was defined as the number of days between hospital admission and the first consult
by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy,
speech therapy).
Results
The median number of days from hospital admission to initiation of acute rehabilitation
therapy was 3 (range=2-7). Multivariable logistic regression models indicated that
each additional day between admission and initiation of acute rehabilitation therapy
was associated with increased odds of poor outcome at 30 days (adjusted odds ratio
[OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify
the predictors of time to initiation of rehabilitation therapy identified heavy drinking
(>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism, and longer length
of stay in the intensive care unit as independent predictors of later initiation of
acute rehabilitation therapy.
Conclusions
Longer time to initiation of acute rehabilitation therapy after ICH may have persistent
effects on poststroke disability. Delays in acute rehabilitation therapy consults
should be minimized and may improve outcomes after ICH.
Keywords
List of Abbreviations:
CI (confidence interval), GCS (Glasgow Coma Scale), ICH (intracerebral hemorrhage), ICU (intensive care unit), LOS (length of stay), mRS (modified Rankin Scale), NIHSS (National Institute of Health Stroke Scale), OR (odds ratio), VIF (variance inflation factor)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: December 21, 2019
Footnotes
Supported in part by the Foundation for Physical Therapy's Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training Grant, the National Institutes of Health's National Center for Advancing Translational Sciences (grant nos. UL1TR000150 and UL1TR001422 ), the National Institute of Neurological Disorders and Stroke (grant no. R01 NS110779 ), the National Research Service Award postdoctoral fellowship ( T-32 HS 000078 and F32HS024366 ), and the Administration for Community Living’s Switzer Research Fellowship (grant no. 90SF0010 ).
Disclosures: E.L. receives a grant from National Institutes of Health National Center for Advancing Translational Sciences (grant no. KL2TR001424 ) and a grant from the National Institute of Health (grant no. L30 NS098427 ). A.N. receives funding from the Agency for Health Research and Quality (grant no. K18 HS023437 ) and the National Institutes of Health (grant no. UL1TR001422 ). The other authors have nothing to disclose.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders played no role in the design, conduct, or reporting of this study.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
