Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

Eric Tanlaka,Cydnee Seneviratne,Theresa Green,Sean Dukelow,Kathryn King-Shier

doi:10.1017/cjn.2019.276

Abstract

We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination. Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors. The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10-9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10-9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10-9, partial η2 0.022) and LOS (p = 1.1 × 10-19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare. Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

Highlights

Stroke is the third leading cause of death and leading cause of adult disability in Canada
We wondered whether the time from acute care admission to inpatient rehabilitation admission had an influence on these same outcomes as suggested in the literature
This study has demonstrated that time since stroke influences rehabilitation length of stay (LOS) and Functional Independence Measure (FIM) change

Summary

Introduction

Stroke is the third leading cause of death and leading cause of adult disability in Canada. In Canada, stroke patients are admitted to rehabilitation units in a median of 12 days from stroke onset with a median total admission Functional Independence Measure (FIM, measure of physical and cognitive disability with a focus on burden of care) score of 74 points for all stroke.[3] Differences in FIM gain based on stroke severity have been reported previously in the literature.[4,5,6]. We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small

Methods

Results

Discussion

Conclusion