Abstract TP164: Impact of Early Admission to Inpatient Rehabilitation Facilities on Functional Outcome With Stroke

Abstract

Objective: To determine whether early admission of patients with stroke into an inpatient rehabilitation facility (IRF) results in motor function improvement during hospitalization. Methods: Data were extracted from the Japan association of rehabilitation database for 2,760 patients admitted to IRFs at 28 centers. Early IRF admission was defined as 14 days from stroke onset to IRF admission. Variables surveyed were age; sex; stroke type; length of stay; period from stroke onset to IRF admission; motor functional independence measure (mFIM) and cognitive FIM at admission and discharge; and modified Rankin Scale score before onset, at admission, and at discharge. In addition, the difference between mFIM at admission and at discharge per day (ΔmFIM/day) was calculated by dividing by the length of stay. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. We defined intensive rehabilitation as rehabilitation conducted at the first quartile (>2.27 hour/day). Multiple regression analysis and instrumental variable analysis were performed to examine the association of early rehabilitation with activities of daily living (ADL) at discharge. Results: ΔmFIM/day was higher in early and intensive rehabilitation. The multiple regression analysis showed that significant improvements in ΔmFIM/day were observed for intensive rehabilitation (partial regression coefficient: 1.56; 95% confidence interval: 0.34-2.8), after controlling for various confounding variables. The instrumental variable analysis showed that ΔmFIM/day was associated with early IRF admission (partial regression coefficient: 0.1; 95% confidence interval: 0.05-0.14). Conclusion: Patients with stroke experience greater improvement in ADL if admitted to an IRF within 14 days after stroke onset.