Stroke Impairment Predictors of Discharge Function, Length of Stay, and Discharge Destination in Stroke Rehabilitation

Wee, Joy; Hopman, Wilma M.

doi:10.1097/01.phm.0000171005.08744.ab

Cited by 88 publications

(87 citation statements)

References 21 publications

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“…54,271 The presence of neglect syndrome can predict a longer rehabilitation stay and lower functional status at discharge. 272 Among patients with less neurological impairment, assessment of balance ability with standardized measures such as the Berg Balance Scale or the Postural Assessment Scale for Stroke can help determine the risk of fall and need for inpatient rehabilitation rather than discharge home with outpatient services [273][274][275] (The Prevention of Falls section provides more information). For patients who can walk, assessment of gait speed with the 10-m walk test can help determine functional ambulatory ability.…”

Section: Assessing Overall Rehabilitation Needsmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,187

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Assessing Overall Rehabilitation Needsmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,187

840

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show abstract

“…21 The quadratic relationship of the admission motor FIM scores with the discharge FIM scores is attributable to well-known ceiling effects in the FIM. The association of longer length of stay with higher discharge FIM scores is complex.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Stein

Ning

et al. 2007

Stroke

216

136

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Background and Purpose-We aim to compare demographics and functional outcomes of patients with stroke in a variety of vascular territories who underwent inpatient rehabilitation. Such comparative data are important in functional prognostication, rehabilitation, and healthcare planning, but literature is scarce and isolated. Methods-Using data collected prospectively over a 9-year period, we studied 2213 individuals who sustained first-ever ischemic strokes and were admitted to an inpatient stroke rehabilitation program. Strokes were divided into anterior cerebral artery, middle cerebral artery (MCA), posterior cerebral artery, brain stem, cerebellar, small-vessel strokes, and strokes occurring in more than one vascular territory. The main functional outcome measure was the Functional Independence Measure (FIM). Repeated-measures analysis of covariance with post hoc analyses was used to compare functional outcomes of the stroke groups. Results-The most common stroke groups were MCA stroke (50.8%) and small-vessel stroke (12.8%). After adjustments for age, gender, risk factors, and admission year, the stroke groups can be arranged from most to least severe disability on admission: strokes in more than one vascular territory, MCA, anterior cerebral artery, posterior cerebral artery, brain stem, cerebellar, and small-vessel strokes. The sequence was similar on discharge, except cerebellar strokes had the least disability rather than small-vessel strokes. Hemispheric (more than one vascular territory, MCA, anterior cerebral artery, posterior cerebral artery) strokes collectively have significantly lower admission and discharge total and cognitive FIM scores compared with the other stroke groups. MCA stroke had the lowest FIM efficiency and cerebellar stroke the highest. Regardless, patients with stroke made significant (PϽ0.001) and approximately equal (Pϭ0.535) functional gains in all groups. Higher admission motor and cognitive FIM scores, longer rehabilitation stay, younger patients, lower number of medical complications, and a year of admission after 2000 were associated with higher discharge total FIM scores on multiple regression analysis. Conclusions-Patients with stroke made significant functional gains and should be offered rehabilitation regardless of stroke vascular territory. The initial functional status at admission, rather than the stroke subgroup, better predicts discharge functional outcomes postrehabilitation.

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“…Impaired balance is a common physical deficit post stroke [4;5], and improved balance has been found to be associated with improved rehabilitation outcomes [6], ability to perform daily activities [7], and walking [8]. Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].…”

Section: Main Textmentioning

confidence: 99%

“…The most common cause of brain damage in adults is stroke, and in Norway approximately 15.000 persons suffer a stroke each year [2]. Rehabilitation should be beneficial for the individual patient as well as for society [3], and adequate assessment tools are needed to examine relevant functional aspects.Impaired balance is a common physical deficit post stroke [4;5], and improved balance has been found to be associated with improved rehabilitation outcomes [6], ability to perform daily activities [7], and walking [8]. Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].…”

mentioning

confidence: 99%

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

Gjelsvik¹,

Breivik²,

Verheyden³

et al. 2011

Disability and Rehabilitation

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Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients with stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test-retest reliability. Method:The TIS was translated according to international guidelines. 201 patients with acute stroke were recruited for the validity study, and 50 inpatients with acquired brain lesions were recruited for the study of intertester and test-retest reliability.Construct validity was analysed using explorative factor analysis, confirmatory factor analysis and item response theory, internal consistency with Cronbach's alpha test, and intertester and test-retest reliability with kappa and intraclass correlation coefficient tests. Results:The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed from the test. Six testlets were hierarchically constructed by combining items from the subscales Dynamic sitting balance and Coordination, and renamed modified TIS-NV (TIS-modNV). After these modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. The test demonstrated good construct validity, excellent internal consistency, as well as high intertester and test-retest reliability for the total score. Conclusions:The TIS-modNV is a valid and reliable scale for use in clinical practice and research.3 Main textPatients with disability due to neurological lesions constitute one of the greatest challenges for society and health services in developed countries [1]. The most common cause of brain damage in adults is stroke, and in Norway approximately 15.000 persons suffer a stroke each year [2]. Rehabilitation should be beneficial for the individual patient as well as for society [3], and adequate assessment tools are needed to examine relevant functional aspects.Impaired balance is a common physical deficit post stroke [4;5], and improved balance has been found to be associated with improved rehabilitation outcomes [6], ability to perform daily activities [7], and walking [8]. Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].The trunk seems particularly important for balance as it stabilizes the pelvis and spinal column [11], being a prerequisite for coordinated use of the extremities in functional activities such as reaching and gait [12]. Impaired trunk control seems common post stroke [13], and trunk control assessed in patients early after stroke has been found predictive of long-term functional improvement [14;15] Even if previous studies using CTT have given important psychometric information, there are several problems with the assumptions underlying CTT such as sample dependency, item equivalence and standard error of measurement [25]. If the data can meet certain rather strict assumptions, Item Response Theory (IRT) overcomes many of these limitations [26;27]. IRT also provides rather sophisticated psyc...

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Stroke Impairment Predictors of Discharge Function, Length of Stay, and Discharge Destination in Stroke Rehabilitation

Cited by 88 publications

References 21 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

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