Effect of inpatient rehabilitation facility care on ninety day modified Rankin score in ischemic stroke patients |
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| Institution: | 1. Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States;2. Ross University School of Medicine Miramar, FL, United States;3. University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States;4. University of Texas Southwestern Medical Center, Dallas, TX, United States;5. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States;6. Department of Neurology, University of Texas Southwestern Medical Center, DALLAS, TX, United States;1. Michigan Medicine, Department of Neurology, US;2. University of Michigan, US;3. Michigan Medicine, Department of Emergency Medicine, US;4. University of Michigan Department of Biostatistics, US;5. University of Michigan Department of Epidemiology, US;1. KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada;2. Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;3. Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada;4. Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;5. Neurovascular Unit, University Health Network Toronto Western Hospital, Toronto, ON, Canada;6. Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada;7. Sinai Health, Toronto, ON, Canada;8. Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada;9. Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada;1. Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada;2. Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India;3. Senior Consultant, Healthcare Financing, National Health Systems Resource Centre, India;4. State Programme Officer, National Programme for Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Programme, Government of Punjab, Chandigarh, India;5. Scientist-G, Program Officer: Cardiovascular Diseases and Neurology, Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India;6. Professor of Neurology and Principal, Christian Medical College, Ludhiana, India;7. School of Nursing, University of Central Lancashire, Preston, United Kingdom;8. NIHR Global Health Research Group on Improving stroke care in India, United Kingdom;1. Department of Neurology, University of Iowa Hospitals and Clinics, 339 Teeters Ct, Iowa City, IA 52246, USA;2. Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru;3. Cerebrovascular Neurosurgery Department, Swedish Neuroscience Institute, Seattle, WA, USA;4. Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru;5. Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Peru;6. Departament of Neurosurgery, Clinica Angloamericana, Lima, Peru;7. Department of Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA |
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| Abstract: | ObjectiveTo determine Inpatient Rehabilitation Facility (IRF) treatment effect on modified Rankin Scale (mRS) scores at 90 days in acute ischemic stroke (AIS) patients.Materials and methodsThis prospective cross-sectional study included 738 AIS patients admitted 1/1/2018-12/31/2020 to a Comprehensive Stroke Center with a Stroke Rehabilitation program. We compared outcomes for patients who went directly home versus went to IRF at hospital discharge: (1) acute care length of stay (LOS), (2) National Institutes of Health Stroke Scale (NIHSS) score, (3) mRS score at hospital discharge and 90 days, (4) the proportion of mRS scores ≤ 2 from hospital discharge to 90 days.ResultsAmong 738 patients, 499 went home, and 239 went to IRF. IRF patients were more likely to have increased acute LOS (10.7 vs 3.9 days; t-test, P<0.0001), increased mean NIHSS score (7.8 vs 4.8; t-test, P<0.0001) and higher median mRS score (3 vs 1, t-test, P<0.0001) compared to patients who went home. At 90 days, ischemic stroke patients who received IRF care were more likely to progress to a mRS ≤ 2 (18.7% increase) compared to patients discharged home from acute care (16.3% decrease). Home patients experienced a one-point decrease in mRS at 90 days compared to those who received IRF treatment (median mRS of 3 vs. 2, t-test, P<0.05).ConclusionsIn ischemic stroke patients, IRF treatment increased the likelihood of achieving mRS ≤ 2 at 90 days indicating the ability to live independently, and decreased the likelihood of mRS decrease, compared with patients discharged directly home after acute stroke care. |
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