Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

Stineman, Margaret G.; Xie, Dawei; Kurichi, Jibby E.; Kwong, Pui L.; Vogel, William; Ripley, Diane Cowper; Bates, Barbara

doi:10.1682/jrrd.2014.03.0084

Cited by 5 publications

(4 citation statements)

References 44 publications

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“…[11,12] There is also some indication in the literature that patients admitted to IRF experience better functional recovery than those admitted to SNF. [13–17] To date, studies comparing IRF to SNF outcomes in the United States have all been observational in nature, and no randomized studies have been performed. As a result, comparing IRF to SNF stroke rehabilitation outcomes is complicated by the differences between the patient populations referred for these 2 different types of care.…”

Section: Introductionmentioning

confidence: 99%

Physiatrist referral preferences for postacute stroke rehabilitation

et al. 2016

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This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists’ referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case.

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Section: Introductionmentioning

confidence: 99%

Physiatrist referral preferences for postacute stroke rehabilitation

et al. 2016

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“…It is said that the appropriate time for discharge from a convalescent hospital is when the patient becomes independent in activities of daily living (ADL) or when there is no improvement in function despite training [ 4 , 5 ]. Although individual rehabilitation by physical therapists, occupational therapists, speech therapists, and other professionals is essential to promoting independence, comprehensive management through multidisciplinary cooperation plays a key role in improving the level of independence in hospitals of convalescence [ 6 ]. Oral health management by dentists may also contribute to such multidisciplinary collaboration to improve ADL in the convalescent period through oral care and recovery of eating patterns and occlusal support [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Association between oral health status and functional independence measure on admission in convalescent hospitalized patients

Hara,

Todayama,

Tabata

et al. 2024

BMC Oral Health

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Background Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. Methods We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient’s age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. Results The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42–97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. Conclusions The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement.

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“…3) Therefore, after the acute phase of brain treatment and prevention of recurrence, it is important to enhance ADLs through rehabilitation to avoid patients becoming bedridden and to enable a return to life similar to that before the onset of stroke. 4) An important goal of stroke treatment is the patient's return home from the hospital.…”

Section: Introductionmentioning

confidence: 99%

“…However, approximately 40% of stroke patients are not able to return home from the convalescent rehabilitation ward. 5) Previous studies reported that some factors preventing patients from returning home were female sex, 9) advanced age, 10,11) stroke severity, 12) poor nutrition, 13) sarcopenia, 14,15) low ADL level before the incidence of stroke, 9) cognitive function, 4,16) and ADL. 11,17) Although ADL is a strong predictor for returning home, patients can return home if appropriate care is available and adjustments have been made to the living environment.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Bowel/Bladder Function and Discharge in Older Stroke Patients in Convalescent Rehabilitation Wards: A Retrospective Cohort Study

Shogenji

Yoshida

Sumiya

et al. 2022

PRM

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Many stroke patients experience motor and cognitive dysfunctions that make living at home challenging. We aimed to identify the factors associated with hospital discharge to home in older stroke patients in convalescent rehabilitation wards where intensive and comprehensive inpatient rehabilitation are performed following acute-phase treatment. Methods: A retrospective cohort study was conducted among 1227 older stroke patients registered in the database of the Council of Kaga Local Stroke Network, Japan, between 2015 and 2019. Patients' basic characteristics, discharge destination, type and severity of stroke, cognitive status, and activities of daily living (ADL) including continence were evaluated. Results: The proportion of subjects discharged to home was 62.3%. The mean hospital stay in the home discharge group was shorter than that in the non-home discharge group (111 days vs. 144.6 days, P <0.001). The following factors were associated with discharge to home: age (adjusted odds ratio [AOR]: 2.801, 95% confidence interval [CI] [1.473, 2.940]; P <0.001), sex (AOR: 1.513, 95% CI [1.112, 2.059]), stroke type (AOR: 1.426, 95% CI [1.013, 2.007]), low cognitive status (AOR: 3.750, 95% CI [2.615, 5.379]), low level of bladder control (AOR: 2.056, 95% CI [1.223, 3.454]), and low level of bowel control (AOR: 2.823, 95% CI [1.688, 4.722]). Conclusions: Age, sex, stroke type, cognitive function, and ADL scores for bladder and bowel control were associated with discharge to home. Improving continence management regarding both voiding and defecation may be a promising care strategy to promote hospital discharge to home in older stroke patients.

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Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

Cited by 5 publications

References 44 publications

Physiatrist referral preferences for postacute stroke rehabilitation

Physiatrist referral preferences for postacute stroke rehabilitation

Association between oral health status and functional independence measure on admission in convalescent hospitalized patients

Relationship between Bowel/Bladder Function and Discharge in Older Stroke Patients in Convalescent Rehabilitation Wards: A Retrospective Cohort Study

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