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Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage

Published:December 21, 2019DOI:https://doi.org/10.1016/j.apmr.2019.11.006

      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)
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