Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study

Abstract

Objective: The aims of this study were to describe patterns and dose of rehabilitation received following stroke and to investigate their relationship with outcomes. Design: This was a prospective observational cohort study. Setting: A total of seven public hospitals and all subsequent rehabilitation services in Queensland, Australia, participated in the study. Subjects: Participants were consecutive patients surviving acute stroke between July 2016 and January 2017. Methods: We tracked rehabilitation for six months following stroke and obtained 90- to 180-day outcomes from the Australian Stroke Clinical Registry. Measures: Dose of rehabilitation – time in therapy by physiotherapy, occupational therapy and speech pathology; modified Rankin Scale (mRS)- premorbid, acute care discharge and 90- to 180-day follow-up. Results: We recruited 504 patients, of whom 337 (median age = 73 years, 41% female) received 643 episodes of rehabilitation in 83 different services. Initial rehabilitation was predominantly inpatient (260/337, 77%) versus community-based (77/337, 21%). Therapy time was greater within inpatient services (median = 29 hours) compared to community-based (6 hours) or transition care (16 hours). Median (Quartile 1, Quartile 3) six-month cumulative therapy time was 73 hours (40, 130) when rehabilitation commenced in stroke units and continued in inpatient rehabilitation units; 43 hours (23, 78) when commenced in inpatient rehabilitation units; and 5 hours (2, 9) with only community rehabilitation. In 317 of 504 (63%) with follow-up data, improvement in mRS was most likely with inpatient rehabilitation (OR = 3.6, 95% CI = 1.7–7.7), lower with community rehabilitation (OR = 1.6, 95% CI = 0.7–3.8) compared to no rehabilitation, after adjustment for baseline factors. Conclusion: Amount of therapy varied widely between rehabilitation pathways. Amount of therapy and chance of improvement in function were highest with inpatient rehabilitation.

A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

“…First, non-university hospitals are often located in smaller towns with a larger geographical coverage than university hospitals; thus, it is possible that patients lived far from rehabilitation centers. Long distances between patients’ homes and rehabilitation centers have previously been associated with decreased probability of referral to rehabilitation 4 . Second, there may have been fewer rehabilitation facilities available in these areas.…”

“…Patients with normal cognition after stroke, ability to follow instructions, and presence of a spouse or relative have been shown to be more likely to receive inpatient rehabilitation 4 . Disability or functional dependency prior to stroke, severe behavioral problems, and living far from a rehabilitation center were identified as unfavorable predictors of receiving inpatient rehabilitation 4 .…”

“…Patients with normal cognition after stroke, ability to follow instructions, and presence of a spouse or relative have been shown to be more likely to receive inpatient rehabilitation 4 . Disability or functional dependency prior to stroke, severe behavioral problems, and living far from a rehabilitation center were identified as unfavorable predictors of receiving inpatient rehabilitation 4 . The European Stroke Organization and Stroke Alliance for Europe stroke care targets for 2030 include national plans that encompass the entire chain of care, access to early rehabilitation for at least 90% of stroke survivors, and review of each patient’s rehabilitation needs at 3 months, 6 months, and annually thereafter 5 .…”

Longitudinal Impact of Community-Based Rehabilitation Programs on Functional Recovery After Stroke: A Scoping Review

“…The Barthel index (BI), Functional independence measure (FIM), Nottingham EADL (NEADL), Reintegration to normal living index (RNLI), modified rankin scale (mRS), and Mayo-portland adaptability inventory (MPAI-4) were used. 8,9,[15][16][17][18][19][20] In the case of FIM, only the mobility portion of the FIM items was evaluated using telephone. 15 Measuring quality of life were identified in only 3 studies, and were measured using the Stroke and aphasia quality of life scale (SAQOL), EuroQol-5-dimension (EQ-5D), and World health organization quality of life-brief (WHOQOL-BREF).…”

“…In particular, in this study, there was a difference in long-term effectiveness depending on the level of the FIM score. A study by Grimley et al 19 compared the effectiveness of community rehabilitation and inpatient rehabilitation, and the effectiveness of inpatient rehabilitation was higher than that of community rehabilitation.…”