Factors Predicting Functional Independence and Discharge Destination among Stroke In-patient – A Retrospective Cohort Study

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Authors (including presenting author) :
LI KT(1), Ng HP(1), Chan YL(1), Chung SF(1), Yu KK(2)
Affiliation :
(1) Department of Occupational Therapy, Kowloon Hospital (2) Department of Rehabilitation, Kowloon Hospital
Introduction :
Stroke is a major cause of disability with an indication for long term rehabilitation. Clinicians are interested in prediction of stroke discharge outcomes which can facilitate customized care plan and allow more time for liaison and making referrals between colleagues but there is a lack of local comprehensive study. This study focuses on various demographic factors and clinical factors in addition to functional data which all can be collected in early phase in a local rehabilitation hospital.
Objectives :
To study which factors predict stroke patients’ (a) clinically significant functional gain and (b) discharge destination after in-patient stroke rehabilitation
Methodology :
The retrospective cohort study included 562 premorbid living at home stroke in-patients transferred to Kowloon Hospital from 1st April, 2015 to 31th March, 2016. The outcomes were (a) “clinically significant functional gain” measured by “one or more level of improvement in Functional Independence Measure motor subscale[FIM-M]”, “achievement of MCID in FIM-M” and (b) “discharge home”. Potential predictors including sociodemographic, clinical characteristics, comorbid conditions, functional performance and rehabilitation process were put into univariate logistic regression. Significant predictors were then put into multivariate logistic regression.
Result & Outcome :
Of 562 stroke patients, 314 (55.9%) were discharged home. 164 (29.2%) had one or more level of improvement in FIM-M and 138 (24.6%) achieved MCID in FIM-M. Significant predictors identified in multivariate logistic regression for (a) ”clinically significant functional gain” were i) younger age groups below 75, ii) higher GCS, iii) haemorrhagic stroke, iv) intermediate FIM motor subscore, v) intermediate and high FIM cognitive subscore. Those for (b) “discharge home” were i) premorbid living with family relative/ attendant ,ii) higher total FIM score on admission, iii) lower Morse Fall Scale , iv) diagnosis of hypertension. To conclude, age group 65-74 were obviously not yet too old to be labelled with limited rehabilitation potential. GCS, Morse fall scale were newly identified significant predictors. Premorbid living with relative/ attendant was a predominating predictor almost 8 times more likely to discharge home. FIM cognitive subscore although was not as powerful as FIM-M, also contributed to discharge home. Early prediction of stroke discharge outcome helps direct intervention strategies in focus of intensive rehabilitation and pre-discharge preparation. Potential use of other predictors should be considered in future.

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