Abstract
Background / Purpose: Organized stroke care within the rehabilitation setting has improved functional outcomes and enable stroke patients to re-integrate within the communities. The Evidence Based Systematic Review for stroke recommends that mild stroke patients with a FIM ® > 80 could receive therapy within the community. However, in Ontario, approximately 20% of mild stroke patients continue to be admitted to inpatient rehabilitation. The purpose of this study is to identify the differences between the mild stroke patients being admitted to inpatient rehabilitation and being discharged home directly from acute care and propose a triage system for the mild stroke population. Methods: A retrospective chart audit was conducted for acute stroke discharges from two regional stroke centres in Ontario. The cohort included patients with a most responsible diagnosis of stroke and a completed AlphaFIM ® Instrument assessment. Stroke cases that had a Projected Full FIM ® score derived from the AlphaFIM ® Instrument with a score > 80, we’re stratified into two groups:discharged home and discharged to inpatient rehabilitation. Data was analyzed using a full and step wise regression model to determine which indicators impacted the discharge disposition. Results: There were 813 patients were eligible for inclusion. The mean age of participants was 72 years, and 54% were males. Overall, 33% of mild stroke patients were admitted to inpatient rehabilitation. The results of the analysis did not explain why so many mild stroke patients are admitted to inpatient rehabilitation. There was a trend toward mild stroke patients with aphasia, inattention and cognitive impairments being admitted to inpatient rehabilitation; however, this was not statistically significant. These two groups did not differ in rates of recurrent stroke or re-admission to hospital at follow-up. Conclusion: The results of this research indicates that milder stroke patients with a Projected Full FIM ® > 80 may effectively be managed in the community if appropriate rehabilitation services are available. Further research is warranted to evaluate functional outcomes of stroke patients within the community rehabilitation setting in order to determine its efficiencies.
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