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Early Inpatient Rehabilitation Admission and Stroke Patient Outcomes

Wang, Hua PhD; Camicia, Michelle MSN, CRRN; DiVita, Magaret PhD; Mix, Jacqueline MPH; Niewczyk, Paulette MPH, PhD

American Journal of Physical Medicine & Rehabilitation: February 2015 - Volume 94 - Issue 2 - p 85–100
doi: 10.1097/PHM.0000000000000226
Original Research Articles: CME Article . 2015 Series . Number 1

Objective The aim of this study was to examine the associations of onset days, time from stroke onset to inpatient rehabilitation facility (IRF) admission, and patient outcomes (FIM gain, discharge destination, and IRF length of stay), using nationally representative data.

Design A secondary data analysis was conducted on a random sample of stroke patients discharged from IRFs in the United States between 2009 and 2011, including mildly (n = 649), moderately (n = 2185), and severely (n = 2390) impaired patients.

Results The study sample had a median of onset days of 5.5, with an interquartile range of 4–9. With the use of 15–365 days as reference, the severely impaired patients had a higher cognition gain (P < 0.01) and were more likely to be discharged to the community (odds ratio, 1.45; 95% confidence interval, 1.12–1.87) when admitted within 7 days, a greater motor gain when admitted within 14 days (P < 0.01), and a lower risk for acute hospital transfer when admitted 3–7 days (odds ratio, 0.62; 95% confidence interval, 0.43–0.90). The moderately impaired patients had a greater motor gain when admitted within 7 days (P < 0.01). Early IRF admission was also associated with a shorter length of stay.

Conclusions Earlier IRF admission was beneficial among severely and moderately impaired patients. IRF admission within 7 days is recommended for stroke patients who achieved medical stability.

From the Kaiser Foundation Rehabilitation Center, Vallejo, California (HW, MC); Uniform Data System for Medical Rehabilitation, Amherst, New York (MD, JM, PN); and State University of New York at Cortland (MD).

All correspondence and requests for reprints should be addressed to: Hua Wang, PhD, Kaiser Foundation Rehabilitation Center, 975 Sereno Dr, Vallejo, CA 94589.

This study has been presented orally or as a poster in the following rehabilitation research conferences: Education Conference of the American Medical Rehabilitation Providers Association, September 17–19, 2013; Annual Conference of the American Academy of Physical Medicine and Rehabilitation, October 3–6, 2013; and American Congress of Rehabilitation Medicine, November 12–16, 2013.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. FIM is a trademark of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

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