Discharge index and prediction for stroke patients in the post-acute stage: Evaluation of the usefulness of Nichijo-seikatsu-kino-hyokahyo

Abstract

Iwai N, Aoyagi Y. Discharge index and prediction for stroke patients in the post-acute stage: Evaluation of the usefulness of Nichijo-seikatsu-kino-hyokahyo. Jpn J Compr Rehabil Sci 2012; 3: 37-41. Introduction:The objective of this study was to evaluate whether or not the Nichijo-seikatsu-kinohyokahyo could be used as an index for predicting ADL independence level or discharge destination. Method: The subjects were 482 patients extracted from the Japanese Association of Rehabilitation Medicine Patient Database (stroke). Multiple regression analysis was performed with a dependent variable, FIM at discharge, and with independent variables including age, pre-onset mRS, post-onset hospital day, number of days hospitalized, motor FIM and cognitive FIM at admission. The Nichijo-seikatsukino-hyokahyo at admission was added to the independent variables, and predictability was compared. Logistic regression analysis was performed with a dependent variable, discharge destination, and with independent variables including age, pre-onset mRS, post-onset hospital day, number of days hospitalized, nursing availability, motor FIM and cognitive FIM at admission. The Nichijo-seikatsukino-hyokahyo at admission was added to the independent variables, and the predictive value was compared. Results: Determination coeffi cient R 2 increased by approximately 0.04 but the predictive value remained the same after adding the Nichijo-seikatsu-kinohyokahyo at admission. Conclusion:The results of analyses on the database used in this study suggest that the Nichijo-seikatsukino-hyokahyo does not yield better predictability for the ADL at discharge or discharge destination.

The difference between measured Nichijo-seikatsu-kino-hyokahyo (NSKH) score and predicted NSKH score derived from ADL is related to FIM gain

“…The range of duration from onset of stroke to admission was 8-60 days, length of hospital stay was 22-180 days, and FIM score at admission was 18-119 (Table 1). The basic attributes of the subjects were similar to those in the nationwide survey [8] and the report of Iwai et al [3], except for the shorter duration from onset of stroke to admission. The subjects were divided into two groups by FIM score at admission: group A consisted of 102 patients with scores of 18-58 and group B consisted of 154 patients with scores of 59-119 .…”

“…Iwai et al [3] created a prediction equation for FIM score at discharge using four items: age, days from onset of stroke to admission, motor FIM at admission, and cognitive FIM at admission, as explanatory variables (R 2 =0.675). The addition of NSKH score to this prediction equation resulted in an increase in R 2 (0.719) of 0.044.…”

“…In addition, the determination of hospital-to-home discharge using age, caring capacity, motor FIM at admission, and cognitive FIM at admission yielded 87.8% of the predictable value, whereas the addition of NSKH score did not change the value. Thus, Iwai et al [3] concluded that "the Nichijo-seikatsu-kino-hyokahyo index is unlikely to result in better prediction of FIM at discharge or predictability of discharge destination".…”

“…Sonoda et al [2] stated that although the NSKH contains elements of activities of daily living (ADL), it remains unclear whether NSKH is compatible with the Functional Independence Measure (FIM), a typical ADL assessment method, and further investigation is required to determine what the NSKH indicates and whether it represents the outcome of rehabilitation. Iwai et al [3] concluded that "the Nichijo-seikatsukino-hyokahyo index is unlikely to result in better prediction of FIM at discharge or predictability of discharge destination". However, if the NSKH is viewed as an assessment method for care needs level (how much nursing care is required), the necessity of the NSKH in Kaifukuki rehabilitation wards will become clear.…”

Predictive factors of home discharge in elderly stroke patients hospitalized in a convalescent rehabilitation ward

“…The results of previous studies investigating the home discharge of stroke patients have indicated that social factors including age, NIHSS, ADL at hospitalization and discharge (degree of paralysis and level of required nursing care), whether oral nutrition is possible, and family aspects as well as rehabilitation intervention units are factors that contribute to home discharge for stroke patients [4,[10][11][12][13][14]. hospitalization, and long-term caregiving ability (evaluated on a scale from 1-5) [14]. In their study, no limitations were placed on age of stroke patient, and it was reported that age was a direct predictive factor for discharge to home.…”