Psychosocial Determinants of Longer Length of Stay on a Canadian Stroke Inpatient Rehabilitation Unit

Abstract

Objective: The relationship between availability of psychosocial resources and inpatient stroke rehabilitation length of stay (LOS) has been inadequately studied. The purpose of this prospective observational study was to identify psychosocial determinants that prolong LOS of patients in a stroke rehabilitation program. Methods: Patients admitted to a multidisciplinary inpatient stroke rehabilitation program in southern Ontario, Canada, were consecutively recruited from October 2008 to August 2010. Patients diagnosed as having had a cerebrovascular event resulting in neurological impairments that required intensive rehabilitation were eligible for the study. Independent variables included psychosocial (awaiting long-term care placement, poststroke depression, inadequate family support, limited access to community home care services), medical (comorbidity, medical complications), neurological (type and location of stroke, neurological deficits), and functional (Functional Independence Measure [FIM] score on admission and discharge, Modified Rankin Disability Scale score) factors. The main outcome measure was length of hospital stay (days). Results: A total of 117 patients were recruited. The mean and median LOS were 49.8 and 45 days respectively. Most patients (92.3%) were discharged home. On multivariate linear regression analysis, the significant determinants associated with longer LOS were awaiting long-term care placement (P<0.001), low admission FIM score (P=0.001), post-stroke depression (P=0.007), difficulties arising from inadequate family support (P=0.033), limited access to community home care services (P=0.035), and presence of medical complication(s) (P=0.039). These 6 factors, 4 of which were psychosocial, accounted for 48.8% of the total variance in LOS. Conclusion: Psychosocial factors were key determinants of longer LOS in addition to medical/neurological factors such as severity of stroke and medical complications. Health care systems must incorporate psychosocial information to a greater extent and recognize its fundamental role in rehabilitation outcomes.

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

“…Thus, our findings may not be generalizable to rehabilitation facilities in countries where LOS is significantly shorter. Nevertheless, a recent study in southern Ontario, Canada, involving n = 117 patients reported a median LOS of 45 days [ 19 ] quite similar to our moderate–RPG patients.…”

“…Previous studies have mostly focused on investigating the prediction of LOS within the full severity spectrum of stroke rehabilitation patients. Such studies involved a wide range of number of participants, e.g., n = 586, [ 29 ] n = 11,983, [ 2 ] n = 117, [ 19 ] n = 3839, [ 30 ] n = 151, [ 31 ] n = 165, [ 23 ] n = 353. [ 32 ]…”

“…As presented in Table 7 , for model #2, T-FIM-Adm standardized Beta is −0.41, therefore, as T-FIM-Adm increases by 1 standard deviation (20.67 points) the LOS decreases by 0.41 standard deviations, the standard deviation of LOS is 27.23, so this constitutes a change of 11.16 days (0.41×27.23 = 11.16); therefore, each 1 point improvement in T-FIM-Adm score predicted a reduction in LOS by 0.54 days. In Yang et al [ 19 ] T-FIM-Adm standardized Beta is −0.375, therefore, as T-FIM-Adm increases by 1 standard deviation (21.84 points) the LOS decreases by 0.375 standard deviations, the standard deviation of LOS is 22.11, so this constitutes a change of 8.29 days (0.375×22.11 = 8.29); therefore, each 1 point improvement in T-FIM-Adm score predicted a reduction in LOS by 0.38 days according to Yang et al [ 19 ]…”

“…[ 16 ] In terms of social factors, there are conflicting reports about whether living alone predicts LOS, for example, Tan et al (longer LOS), [ 17 ] Saxena et al (shorter LOS). [ 18 ] Besides, inadequate family support [ 19 ] and environmental factors (e.g., home modifications) may delay LOS. [ 20 ]…”