Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?
BACKGROUND
We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.


METHODS
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.


RESULTS
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.


CONCLUSION
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.
['Tanlaka|Eric|E|0000-0002-0897-8367', 'King-Shier|Kathryn|K|', 'Green|Theresa|T|', 'Seneviratne|Cydnee|C|', 'Dukelow|Sean|S|0000-0002-0609-981X']
D000368:Aged D000369:Aged, 80 and over D004185:Disability Evaluation D005260:Female D006760:Hospitalization D006801:Humans D007297:Inpatients D008297:Male D008875:Middle Aged D020127:Recovery of Function D012189:Retrospective Studies D012720:Severity of Illness Index D020521:Stroke D000071939:Stroke Rehabilitation D013997:Time Factors D061665:Time-to-Treatment
Inpatient rehabilitation Stroke Outcomes Length of time waiting