Descriptive Data Analysis Examining How Standardized Assessments Are Used to Guide Post–Acute Discharge Recommendations for Rehabilitation Services After Stroke

Bland, Marghuretta D.; Whitson, Michelle; Harris, Hilary; Edmiaston, Jeff; Connor, Lisa Tabor; Fucetola, Robert; Carter, Alexandre; Corbetta, Maurizio; Lang, Catherine E.

doi:10.2522/ptj.20140347

Cited by 18 publications

(9 citation statements)

References 61 publications

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“…Prediction of final discharge disposition and pressures to discharge patients from acute hospital beds have a strong influence over assessment and recommendations regarding rehabilitation following stroke. 24 , 30 In Queensland, the major options for discharge which provide assistance with personal cares are residential aged care facilities and ‘Transition Care’ which is an aged care service in Australia providing low intensity rehabilitation in a mixture of home (supported discharge) and aged care facility settings. 31 Transition care packages have limited availability consistent with the small proportion (6%) of more severely impaired patients in our cohort initially discharged to this service.…”

Section: Discussionmentioning

confidence: 99%

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

et al. 2019

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Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia. Objective To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Design Prospective observational cohort study. Setting Seven public hospitals in Queensland, Australia. Subjects Consecutive patients surviving acute stroke. Measures Rehabilitation selection processes: assessment for rehabilitation needs, referral for rehabilitation, receipt of rehabilitation. Functional impairment following stroke: modified Rankin Scale (mRS). Results We recruited 504 patients, median age 73 years (IQR 62, 82) between July 2016 and January 2017. Of these, 90% (454/504) were assessed for rehabilitation needs, 76% (381/504) referred for rehabilitation, and 72% (363/504) received any rehabilitation. There was significant variation in all rehabilitation selection processes across sites (p<0.05). In multivariable analyses (Odds Ratio; 95% CI), stroke unit care (2.7; 1.1, 6.6) and post stroke functional impairment (severe stroke mRS 4-5: 10.9; 4.9, 24.6) were associated with receiving an assessment for rehabilitation. Receipt of rehabilitation was more likely following assessment (6.5; 2.9, 14.6) but less likely in patients with dementia (0.2; 0.1, 0.9), end-stage medical conditions (0.4; 0.2, 0.8) or ischaemic stroke (0.4; 0.1, 0.9). The odds of receiving rehabilitation increased with greater impairment: Odds Ratio 3.0 (1.5, 4.9) for mRS 2-3 and 12.5 (6.5, 24.3) for mRS 4-5. Among patients with mild-moderate impairment (mRS 2-3), 39/117 (33%) received no rehabilitation. Conclusions There was significant inter-site variation in rehabilitation selection processes. The major factors influencing rehabilitation access were assessment for rehabilitation needs, co-morbidities and post stroke functional impairment. Gaps in access to rehabilitation were found in those with mild to moderate functional impairment.

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Section: Discussionmentioning

confidence: 99%

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

et al. 2019

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“…5 Specifically, transition planning focusing on factors such as overall health, comorbidities, age, caregiver support, mobility, cognition, and self-care have been shown to be essential for successful transitions. 6,7 Unfortunately, critical gaps in transition/discharge planning for people with stroke remain. 8…”

Section: Accepted Manuscript 4 Trmentioning

confidence: 99%

From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke

Miller

Lin

Neville

2019

Archives of Physical Medicine and Rehabilitation

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Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these five recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes, (2) utilizing transition specialists, (3) implementing a patient-centered discharge checklist, (4) utilizing standardized outcome measures, and (5) establishing partnerships with community wellness programs. Due to changes in healthcare policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during post-stroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand-off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (early supported discharge, planned pre-discharge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.

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“…The OTRs involved in the acute treatment of stroke are required to predict the functional prognosis of treated patients with MCA infarction from an early stage [11]. To achieve this at the Barnes-Jewish Hospital, the OTR will perform several functional evaluations as an initial assessment within a short period following the onset of MCA infarction [12]. Although the types of outcomes are different, their work is very similar to that of OTRs working in Japanese acute care hospitals.…”

Section: Introductionmentioning

confidence: 99%

Eating and Grooming Abilities Predict Outcomes in Patients with Early Middle Cerebral Infarction: A Retrospective Cohort Study

Suzuki

Tsubakino

Fujii

2020

Occupational Therapy International

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Patients with cerebrovascular disorders are often forced to rest, with early prognosis made by bedside examination. However, overloading, for example, talking for a long time, may worsen the condition. We hypothesized that activities of daily living (ADL) from the Functional Independence Measure (FIM) that were actually performed regularly are useful to predict prognosis. The present study was aimed at determining the predictive items related to predicting prognosis from the status of early motor paralysis and ADL in patients with acute middle cerebral artery (MCA) infarction. We examined 367 patients with MCA infarction for Brunnstrom recovery stage (BRS) and FIM within 4 days of admission and modified the Rankin Scale before onset and just before discharge. Logistic regression analysis was used to compare two groups of patients based on their postdischarge destination (Home/another hospital or facility). The logistic regression analysis showed the following: BRS Hand: odds ratio (OR) 1.641 (95% CI 1.642 (1.336–2.017), p<0.001); FIM Grooming: OR 1.279 (95% CI 1.220–1.807, p<0.001); and FIM Eating: OR 1.280 (95% CI 1.102–1.488, p<0.001). On the other hand, the ROC analysis showed the ROC area for Eating to be 0.830 (95% CI 0.787–0.874), for Grooming to be 0.81 (95% CI 0.765–0.865), and for BRS Hand to be 0.805 (95% CI 0.760–0.851). The BRS Hand and FIM Eating and Grooming domains were identified as predictive factors using the following cutoff points: BRS Hand stage V and FIM scores of 5 for Eating and 4 for Grooming. The cutoff points for the BRS Hand and FIM Eating revealed that, at a minimum, such patients can use the nonaffected hand. The presence of cognitive dysfunction or dysphagia affects these domains. Therefore, these results suggested that Eating and Grooming are appropriate as evaluation items.

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Descriptive Data Analysis Examining How Standardized Assessments Are Used to Guide Post–Acute Discharge Recommendations for Rehabilitation Services After Stroke

Abstract: Participants poststroke can be classified into meaningful groups based on assessment scores from their initial physical therapist and occupational therapist evaluations. These assessment scores, in part, guide poststroke acute care discharge recommendations.

Cited by 18 publications

References 61 publications

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke

Eating and Grooming Abilities Predict Outcomes in Patients with Early Middle Cerebral Infarction: A Retrospective Cohort Study

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