Receiving Rehabilitation Services Research Articles

The Treatment Expectation Questionnaire Tool: A Cross-Cultural Adaptation and Psychometric Evaluation in Turkey.

Patients' general treatment expectations are an important indicator of the outcomes of the various treatments they will receive. There is a need for valid and reliable assessment tools that measure the expectations of patients receiving rehabilitation services. This study aimed to translate and validate the Treatment Expectations Questionnaire (TR.TEX-Q) in Turkish patients to assess their treatment-specific expectations. 150 physiotherapy patients were enrolled in the study. The original version of the Treatment Expectation Questionnaire was translated into Turkish. Cronbach's α was used to investigate internal consistency. Intraclass correlation coefficients were used to assess test-retest reliability. Pearsons's correlation was used to calculate convergent and divergent validity. Principal component analysis produced a 15-items scale which had a 6-factors structure. Cronbach's α values ranged from .649 to .879. Test-retest reliability was high for total score and for all subscales. The ICC was between .622 and .852, p < .001. TR.TEX-Q showed good convergent validity, a moderate correlation was found between the Positivity Scale (rho = .45, p < .001). For divergent validity, low to moderate correlation was found between the TR.TEX-Q and the HADS scores. The Turkish version of Treatment Expectation Questionnaire has good reliability and validity data in terms of evaluating the treatment expectations of patients who will receive physiotherapy.

Sex Disparities in the Direct Cost and Management of Stroke: A Population-Based Retrospective Study.

(1) Background: Previous studies have identified disparities in stroke care and outcomes by sex. Therefore, the main objective of this study was to evaluate the average cost of stroke care and the existence of differences in care provision by biological sex. (2) Methods: This observational study adhered to the recommendations of the STROBE statement. The calculation of costs was performed based on the production cost of the service or the rate paid for a set of services, depending on the availability of the corresponding information. (3) Results: A total of 336 patients were included, of which 47.9% were women, with a mean age of 73.3 ± 11.6 years. Women were typically older, had a higher prevalence of hypertension (p = 0.005), lower pre-stroke proportion of mRS 0-2 (p = 0.014), greater stroke severity (p < 0.001), and longer hospital stays (p = 0.017), and more were referred to residential services (p = 0.001) at 90 days. Women also required higher healthcare costs related to cardiovascular risk factors, transient ischemic strokes, institutionalization, and support needs; in contrast, they necessitated lower healthcare costs when undergoing endovascular therapy and receiving rehabilitation services. The unadjusted averaged cost of stroke care was EUR 22,605.66 (CI95% 20,442.8-24,768.4), being higher in women [p = 0.027]. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%). At one year post-stroke, the percentage of women not evaluated for a degree of dependency was lower (p = 0.008). (4) Conclusions: The total unadjusted costs averaged EUR 22,605.66 (CI95% EUR 20,442.8-24,768.4), being higher in women compared to men. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%).

Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic

BackgroundGuillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. ObjectiveTo evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. MethodsBetween 2016 and 2020, telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. ResultsForty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9–34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5–100), improved disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0–3] vs. 4.5 [IQR = 4–5], p < 0.001), and had better ability to walk without assistance (median GDS = 2, IQR = 0–2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. ConclusionsThis study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p&lt;0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p&lt;0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p&lt;0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Quality of Life among Individuals with Stroke in Jordan

Abstract &#x0D; Background and aims: Stroke has long-term consequences for the functional performance of daily activities. Evaluating the impact of stroke on health and wellbeing is essential in designing stroke-specific programs supporting home and community participation. This study described the impact of stroke on quality of life as reported by stroke survivors. Additionally, this study examined the effect of different personal and clinical characteristics on the quality of life among adults with stroke. Materials and Methods: This cross-sectional study encompassed a sample of 64 adults with stroke (mean age 58.9 years) who are currently receiving rehabilitation services after stroke onset. Outcome measures included the Stroke Impact Scale (SIS) and its subdomains to assess the self-perceived disability following a stroke. The data analysis plan included MANOVA, followed by ANOVA of main effects and post-hoc analyses. Results: Jordanian individuals with stroke had a mean SIS total score of 59.9 (SD ±15.4, Range 25.8– 94) indicating moderate levels of quality of life following stroke. Furthermore, patients reported that hand function, strength, activities of daily living (ADL), participation, and emotions domains received lower mean scores of SIS in these areas. Participants with a higher number of previous strokes had significantly lower emotional subdomain scores on the SIS (p=0.001). Participants with aphasia had significantly lower scores in the memory (p&lt; 0.001) and communication subdomains (p=0.0001). Conclusion: Individuals with stroke reported moderate levels of disability after stroke onset. Having aphasia, and an increased number of previous strokes were associated with greater challenges in quality of life following stroke.&#x0D; Keywords: Stroke, Quality of Life, Performance, Rehabilitation.

Abstract TMP30: The Impact of Social Influences on Rehabilitation Services Utilization After Stroke

Introduction: Evidence supports that early initiation of rehabilitation is important for patient outcomes after stroke. Thus, determination of patients needing rehabilitation during their acute hospitalization is critical. We assessed the impact of demographic, clinical, and county-level social influences on rate of transfer to a rehabilitation facility after acute stroke hospitalizations. Methods: Using Get with the Guidelines-Stroke registry data and Institute for Health Metrics and Evaluation data, we fitted univariate and multivariate generalized linear mixed models (GLMM) with demographic, clinical, and social variables to determine how social influences of health impacted variances in transfers to rehabilitation facilities. Specific county-level variables assessed were related to education, income, employment, home ownership, and being foreign born. Results: Among 912,488 patients who were assessed or received rehabilitation services due to acute ischemic or intracerebral hemorrhagic stroke, 33.4% of them were transferred to rehabilitation facilities. Multivariate analyses of patient-level demographic and clinical variables achieved an Akaike Information Criterion (AIC) of 925780 (21.0% reduction from the base model) largely driven by clinical factors (mRS at discharge, initial NIHSS, and initial exam findings). When county-level variables related to social influences of health were incorporated, AIC decreased by 23.4% to 871806, indicating a better model fit largely driven by education level. Conclusions: Social influences of health impact transfer to rehabilitation facilities after acute stroke hospitalization. Future studies should focus on individual (versus county-level) metrics of social influences of health and their impact on access to rehabilitation. This information should be used to develop interventions to improve the equity of rehabilitation utilization after stroke.

Assessment of functioning indicators of people with disability and impaired neuromuscular, skeletal, and movement-related functions based on the International Classification of Functioning, Disability, and Health considering environmental barriers

BACKGROUND: The need and realization of the rights to rehabilitation of people with disability is a key guideline in building a system of rehabilitation and habilitation in the Russian Federation. The need for comprehensive rehabilitation for disorders of neuromuscular, skeletal, and movement-related functions (NSMFs) has not yet been fully studied.&#x0D; AIM: To assess functioning indicators of persons with disability and impaired NSMFs based on the International Classification of Functioning, Disability, and Health (ICF) considering environmental barriers.&#x0D; MATERIALS AND METHODS: A continuous controlled medical and social study was conducted. The study enrolled 257 respondents recognized as having a disability, which were divided into two groups. The target group (n=137) consisted of patients with NSMFs receiving rehabilitation services at a rehabilitation center, and the control group included 120 respondents with NSMFs who passed the initial examination at the Bureau of Medical and Social Expertise.&#x0D; RESULTS: Despite the high need for comprehensive rehabilitation measures for people with disability and NSMFs of all age groups, patients with milder disease receive the preferential right to rehabilitation.&#x0D; CONCLUSIONS: The results show that the use of ICF determinants in the description of functional and structural disorders and the main barriers at the stages of medical and social examination allows the identification of existing barriers in people with disability and more accurately and objectively determine the need for rehabilitation measures.

Pectoralis Muscle Dosimetry and Posttreatment Rehabilitation Utilization for Patients With Early-Stage Breast Cancer

Up to 50% of women treated for localized breast cancer will experience some degree of arm or shoulder morbidity. Although radiation is thought to contribute to this morbidity, the mechanism remains unclear. Prior studies have shown biologic and radiographic changes in the pectoralis muscles after radiation. This study thus aimed to investigate the relationship between radiation to the pectoralis muscles and referrals for rehabilitation services posttreatment for arm and shoulder morbidity. A retrospective 1:1 matched case-control study was conducted for patients with breast cancer who were and were not referred for breast or shoulder rehabilitation services between 2014 and 2019 at a single academic institution. Patients were included if they had a lumpectomy and adjuvant radiation. Patients who underwent an axillary lymph node dissection were excluded. Cohorts were matched based on age, axillary surgery, and use of radiation boost. Muscle doses were converted to equivalent dose in 2 Gy fractions assuming an α:β ratio of 2.5 and were compared between the 2 groups. In our cohort of 50 patients of a median age 60 years (interquartile range, 53-68 years), 36 patients (72%) underwent a sentinel lymph node biopsy in addition to a lumpectomy. Although pectoralis muscle doses were generally higher in those receiving rehabilitation services, this was not statistically significant. Pectoralis major V20-40 Gy reached borderline significance, as did pectoralis major mean dose (17.69 vs 20.89 Gy; P=.06). In this limited cohort of patients, we could not definitively conclude a relationship between pectoralis muscle doses and use of rehabilitation services. Given the borderline significant findings, this should be further investigated in a larger cohort.

Comparison of Mental Health of Mothers of Children With Disorders Speech and Language With an Emphasis on the Duration of Receiving Rehabilitation Services

Comparison of Mental Health of Mothers of Children With Disorders Speech and Language With an Emphasis on the Duration of Receiving Rehabilitation Services

Occupational survey-based evidence of health status and welfare problems of workers with pneumoconiosis in China.

Pneumoconiosis is the most dangerous occupational disease in China. According to unofficial records, nearly million migrant workers were affected by pneumoconiosis in 2011, with the number increasing annually. Among them, a large number of migrant workers suffering from pneumoconiosis were not medically diagnosed. Therefore, fundamental questions remain unanswered: what is the background of workers who receive a diagnosis of pneumoconiosis, and how does pneumoconiosis affect their future and well-being? In this study, we identified and surveyed 1,134 workers with pneumoconiosis in seven selected regions in China with substantially high incidences of pneumoconiosis by using a combination of cluster sampling, convenience sampling, and snowball sampling. We used demographic, medical, and rehabilitation conditions and welfare questionnaires to collect the data. The findings highlighted the socioeconomic status of patients with pneumoconiosis. The majority of workers with pneumoconiosis were adult men who had received no higher education, who lived in rural households, and who were employed in mining or manufacturing industries. Among these workers, 52.8% had been exposed to dust at work for more than 10 years, and 53.1% received a diagnosis of stage II or III pneumoconiosis. More than half of the workers (569 workers, 50.2%) did not receive comprehensive, routine treatment; 33.4% (379 workers) visited a doctor when they experienced physical discomfort, and 6.6% (75 workers) never received treatment. Only 156 workers (13.8%) received rehabilitation services, whereas 978 workers (86.2%) never did. The study results also revealed the severe financial difficulties faced by patients with pneumoconiosis. Only 208 workers (18.3%) had access to work-related injury insurance, with the cost of pneumoconiosis treatment being a substantial burden for 668 workers (60.6%). In this study, we explored the existing health and welfare problems faced by workers with pneumoconiosis in China and identified the social injustice and health disparities that these workers experience. We also clarified the primary challenges in implementing safety, health, and welfare policies for these workers and those who are exposed to high-risk environments, such as those working in mining.

Stroke resource utilisation and all-cause mortality in Thailand 2017–2020: A retrospective, cross-sectional study

ObjectiveTo determine resource utilisation, costs and all-cause mortality related to stroke in Thailand.DesignRetrospective, cross-sectional study.Setting and participantsPatients with first-ever stroke in the Thai national claims database between 2017 and 2020...

Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry

Purpose While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth. Methods Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90–120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay’s four-step approach. Results Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with. Conclusion The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.

Exploring the Influence of the Coronavirus Disease 2019 Pandemic on the Accessibility of Rehabilitation Services Provided to Children with Disabilities: A Cross-Sectional Study.

Background and Objectives: Children with disabilities (such as cerebral palsy, autistic spectrum disorder, and Down syndrome) are the most vulnerable and marginalized subset of the population, representing 2.7% of the total population of Saudi Arabia. The COVID-19 outbreak might have disproportionately affected children with disabilities, augmented their isolation, and induced severe disruptions to the services on which these children rely. Limited research has been conducted in Saudi Arabia to understand the impact of the COVID-19 pandemic on the rehabilitation services provided to children with disabilities and barriers. This study aimed to investigate the effect of the lockdown implemented as a result of the coronavirus disease-2019 (COVID-19) pandemic on the accessibility of rehabilitation services, including communication, occupational therapy, and physical therapy, in Riyadh, Kingdom of Saudi Arabia. Materials and Methods: In this cross-sectional study, a survey was conducted between June and September 2020 during the lockdown in Saudi Arabia. A total of 316 caregivers of children with disabilities from Riyadh participated in the study. The accessibility of rehabilitation services provided to children with disabilities was assessed by designing a valid questionnaire. Results: A total of 280 children with disabilities received rehabilitation services before the COVID-19 pandemic and showed improvement following therapeutic sessions. However, during the pandemic, most children stopped receiving therapeutic sessions because of lockdown, which deteriorated their condition. This shows a significant reduction in the accessibility of the rehabilitation services provided during the pandemic. Conclusions: The findings of this study revealed a drastic decline in services provided to children with disabilities. This caused a notable deterioration in the abilities of these children.

Autism services in low-resource areas

To explore access to intervention services for children with autism spectrum disorder (ASD) in Jordan. We used prospective cross sectional design and survey methodology to collect information from the parents of a convenient sample of children with ASD aged 2.5-17 years and who attended pediatric neurology clinics in 3 different university affiliated hospitals in 3 geographic areas in Jordan from February to December 2018. We interviewed parents of 274 children with ASD. One hundred ninety-six (71.5%) received rehabilitation services. The average age at first session was 3.9 years. The most common services received were behavioral therapy (182; 66.4%). The average weekly hours were highest for speech and behavioral therapy; 6.25 and 6.64 respectively. Private centers for developmental disabilities were the most commonly used followed by private centers for ASD. The most common barriers were costs (138; 58%) and transportation (88; 37.5%). Most parents (198; 72.3%) prefer to receive rehabilitation in a specialized center for autism, and most did not want to receive training to train their child themselves. Most children with ASD in Jordan have limited access to recommended autism services. The development of future interventions must consider the needs of those living in limited resource regions.

Association Between Laboratory Values and Adverse Events in Adults Post-Hematopoietic Stem Cell Transplant During and After Rehabilitation

ObjectiveThe objective of this study was to examine the relationship between adverse events (AEs) and critical events (CEs) during and after rehabilitation in cancer patients post-hemopoietic stem cell transplant (HSCT) or bone marrow transplant (BMT) and to identify whether particular laboratory values are associated with increased risk of AEs or CEs. DesignA retrospective chart review (2012-2017) of hospitalized patients ages 18-75 years who received a diagnosis of cancer and BMT or HSCT receiving rehabilitation services SettingUrban Midwest tertiary, research and academic hospital. ParticipantsIn total, 99 hospitalized adults with HSCT or BMT participated in 300 rehabilitation sessions. InterventionsPhysical or occupational therapy using a symptom-based approach in which patient symptoms were monitored and therapy was adjusted in real time Main Outcome MeasuresIncidence of AEs or CEs occurring during or within 48 hours of rehabilitation. ResultsA total of 300 rehabilitation sessions were carried out where 99.7% had 1 or more laboratory values outside reference range. In only 3.3% of therapy sessions an AE occurred during or within 2 hours of rehabilitation. Within 48 hours postrehabilitation, AEs occurred in 22.3% and CEs in 4%. No laboratory value was significantly associated with increased risk of AEs or CEs during rehabilitation. A hemoglobin <8.0 g/dL conferred an increased risk of AEs (odds ratio [OR], 2.85-6.89) depending on timeframe analyzed and overall risk of CE (OR, 3.75). Lower hemoglobin levels (<7.5 g/dL and <7.0 g/dL) did not increase this risk. Low platelets (<25 k/μL) increased the risk of AEs on day 1, 2 and overall (OR, 2.5-2.72) and overall risk of CEs (OR, 6.62). ConclusionsOur research demonstrates a low rate of AEs and CEs during or within 2 hours of rehabilitation but supports the need to monitor patients when hemoglobin is <8 g/dL or platelets are <25 k/μL due to the increased risk of events.

Organization of rehabilitation services for youth with physical disabilities and mental health problems: A scoping review.

Youth with childhood-onset physical disabilities receiving rehabilitation services often present with many complex needs. Emerging evidence confirms co-occurrence of mental health problems in this population is common, and mental health is often overlooked during rehabilitation for chronic physical conditions. For example, symptoms of depression and anxiety are frequently present in adolescents with physical disability such as spina bifida or Duchenne muscular dystrophy, and access to mental health services is often limited. Addressing mental health concerns for this age group is particularly critical as it encompasses a challenging transition to adulthood. Building upon findings from a recent scoping review on the co-occurrence of physical disabilities and mental health problems, this paper synthesizes scientific literature related to the organization and delivery of services for youth with co-occurring childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida) and mental health problems (e.g., depression, anxiety). A scoping review protocol stemming from Arksey & O'Malley's framework and updated guidelines from the Joanna Briggs Institute was developed. Four databases (Medline, PsycINFO, CINAHL, Embase) were searched. The search was limited to French or English peer-reviewed articles published between 2000 and 2021. Articles included were primary papers addressing: 1) youth aged 15 to 24 with a childhood-onset physical disability, 2) mental health problems, and 3) healthcare service organization or delivery. They were screened by two reviewers and discussed with a third to establish consensus on the inclusion criteria and resolve disagreements. Sixteen articles were retained from the 1,010 screened. Many (9/16) were from the United States. Two models were found: the Biopsychosocial, Collaborative, Agency-Based Service Integration Approach (including psychiatry in a pediatric rehabilitation hospital) and the Client Network Consultation (an interagency collaboration in mental health care for children with complex healthcare needs). Twelve key principles for service organization and delivery were identified and categorized into: collaboration and coordination, training and support, and delivery of care. Identified principles can guide improved service delivery for this population. Highlighted research gaps include the need for developing models of collaborative healthcare delivery and subsequently evaluating their effectiveness.

Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania – a cross-sectional survey

ObjectivesTo describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania.DesignA cross-sectional community survey was conducted from November 2020 to June...

Peculiarities of Adaptive and Rehabilitation Processes of Children with Special Educational Needs

The paper examines the peculiarities of the adaptive and rehabilitation processes of children with special educational needs. It was found that one of the most significant issues of rehabilitation work with children with special educational needs is to create the conditions for their integration into society. This stipulates the determination of the state of their adaptive and rehabilitation potential formation suggesting identification of social characteristics and social relations of the children with special educational needs; definition of the levels of their learning opportunities, skills and abilities development; elucidation of the peculiarities of intra-family relations in families bringing up children with special educational needs; research of rehabilitation processes features being passed by children with special educational needs. For studying the state of adaptive and rehabilitation potential formation in working with children with special educational needs, we have conducted a diagnostic study among children with special educational needs who receive rehabilitation services at the Shepetivka City Center for Social Rehabilitation of Disabled Children of Khmelnytskyi region. The parents of the children took part in the study as well. The results of the diagnosis revealed that the children with special educational needs are dominated by medium and low levels of formation of self-concept and comprehention of their relations with the social environment; they are characterized by medium and low levels of general mental development; children with special educational needs suffer hostility and conflict in their families, while their parents experience feelings of guilt, anxiety, and mental stress; the difficulties being faced by the children with special educational needs during the rehabilitation process are mainly related to their focusing on their own illness. In this regard, we have developed and substantiated the forms and methods for regulating the adaptive and rehabilitation processes in working with children with special educational needs, which, in our opinion, should be applied by specialists at the centers for the social rehabilitation of children with disabilities.

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

BackgroundDespite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury.MethodsPatients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles.ResultsOverall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL.ConclusionsPatients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach.Trial registrationClinicalTrials.gov NCT02210221.

A Comparison of Acute Ischemic Stroke Patients Discharged to Inpatient Rehabilitation vs a Skilled Nursing Facility: The Paul Coverdell National Acute Stroke Program

ObjectiveTo compare the sociodemographic, clinical, and hospital related factors associated with discharge of acute ischemic stroke (AIS) survivors to inpatient rehabilitation (IRF) and skilled nursing facility (SNF) rehabilitation services. DesignRetrospective descriptive study from the Paul Coverdell National Acute Stroke Program (PCNASP) participating hospitals during 2016 to 2019. Setting9 Participating states from PCNASP in United States. Participants130,988 patients with AIS from 569 hospitals (N=337,857). InterventionsNot applicable. Main Outcome MeasureDischarge to IRF and SNF. ResultsPatients discharged to a SNF had longer length of hospital stay, more comorbidities, and higher modified Rankin scores compared with patients discharged to an IRF. Nine characteristics were associated with being less likely to be discharged to an IRF than an SNF: older age (85+ years old, adjusted odds ratio [AOR]=0.20 [confidence interval [CI]=0.18-0.21]), identifying as non-Hispanic Black (AOR=0.85 [CI=0.81-0.89]), identifying as Hispanic (AOR=0.80 [CI=0.74-0.87]), having Medicaid or Medicare (AOR=0.73 [CI=0.70-0.77]), being able to ambulate with assistance from another person (AOR=0.93 [CI=0.89-0.97]), being unable to ambulate (AOR=0.73 [CI=0.62-0.87]) and having comorbidities, prior stroke (AOR=0.69 [CI=0.66-0.73]), diabetes (AOR=0.85 [CI=0.82-0.88]), and myocardial infraction or coronary artery disease (AOR=0.94 [CI=0.90-0.97]). Four characteristics were associated with being more likely to be discharged to an IRF than an SNF: being a man (AOR=1.20 [CI=1.16-1.24]), and having a slight disability (Rankin Score 2) (AOR=1.41 [CI=1.29-1.54]), being at larger hospitals (200-399 beds: AOR=1.31 [CI=1.23-1.40]; 400+ beds: AOR=1.29 [CI=1.20-1.38]), and being at a hospital with stroke unit (AOR=1.12 [CI=1.07-1.17]). ConclusionThis study found differences in demographic, clinical, and hospital characteristics of AIS patients discharged for rehabilitation to an IRF vs SNF. The characteristics of patients receiving rehabilitation services may be helpful for researchers and hospitals making policies related to stroke discharge and practices that optimize patient outcomes. Populations experiencing inequities in access to rehabilitation services should be identified, and those who qualify for rehabilitation in IRF should receive this care in preference to rehabilitation in SNF.