Stroke Rehabilitation: Predicting Inpatient Length of Stay and Discharge Placement

Abstract

Background Stroke is the third leading cause of death in Hong Kong. As stroke is frequently followed by prolonged disability and functional dependence, a considerable number of stroke survivors require rehabilitation to reduce their degree of disability and handicap, and to enhance their chances of returning to functional independence at home. Objectives This study was undertaken to identify indicators that predict length of hospital stay (LOS), gain in Functional Independence Measure (FIM), and discharge placement after completion of a stroke rehabilitation programme in Hong Kong. Methods This was a retrospective study of 1,111 stroke patients who were admitted to Kowloon Hospital between 1 April 2000 and 31 March 2002, and who were included in data analysis. Data were gathered on age, gender, marital status, pre- and post-hospital living setting, pre- and post-hospital living status, side of impairment, functional status in terms of admission and discharge FIM subtotal scores in self-care, sphincter control, transfer, locomotion, communication, and social cognition. Outcome was measured by LOS, FIM gain, and discharge placement. Multiple linear regression was used to identify significant predictors of LOS and FIM gain after rehabilitation. A binary logistic regression was computed to identify significant predictors of discharge placement. Results Significant direct predictors of rehabilitation LOS were age, FIM gain, admission FIM subtotal scores for locomotion, transfer, communication, self-care and pre-hospital living in an institution. The mean gain in FIM score was 19.8 points (range, −10 to 69; SD, 12.5). Significant predictors of discharge placement were age, gender, marital status, pre-hospital living alone versus living with family, pre-hospital living in an institution versus living with family, admission FIM sub-total score in locomotion, self-care, and social cognition. Conclusions This study determined the predictors of discharge outcome for stroke rehabilitation in Hong Kong, which are useful to health care providers. Occupational therapists, who are specialists in functional assessment and training, can start an appropriate treatment plan earlier to facilitate safe discharge, and collaborate with physicians to select appropriate resettlement plans for their patient after discharge.