Deans' stroke musings: The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large, US data base

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, October 19, 2012

The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large, US data base

Don't these people even consider looking at the actual damage to the brain, (penumbra damage vs. dead brain)? Rather than the secondary results as identified by the FIM score?
http://informahealthcare.com/doi/abs/10.3109/09638288.2012.717587

Purpose: To determine whether functional ability at admission and demographics predict discharge placement after inpatient rehabilitation for older adults recovering from stroke. Method: In this retrospective study, we examined records of 31,910 adults 65 years of age and older who were admitted for inpatient rehabilitation post-stroke. Binary logistic regression was used with the outcome of placement and potential predictors of the admission Functional Independence Measure (FIM) score, age, sex and marital status. Results: The average admission FIM was 60.0 out of 126; the average FIM at discharge was 84.8. The mean age was 77.7 ± 7.3 years, 57% were female and 52.5% were not married. More than three quarters of the patients were discharged to home. Odds ratios (ORs) with 95% confidence intervals (CIs) showed that patients with a FIM score below the mean of our sample (OR = 5.8, CI = 5.5–6.2), older than the mean age of our sample (OR = 1.6, CI = 1.5–1.7), and who were not married (OR = 1.9, CI = 1.8–2.0) (p-values less than 0.001) were more likely to be discharged to residential care. Sex was not predictive of placement. Conclusion: The admission FIM was an important predictor of discharge placement after rehabilitation in older adults. Age and marital status were also significant predictors of discharge placement. Sex was not a significant predictor.

Implications for Rehabilitation

Functional ability, age and marital status are significant predictors of discharge placement after stroke rehabilitation.
Those who have lower admission Functional Independence Measure scores, are older, and are not married are more likely to be discharged to residential care than their counterparts who return home.
Sex is not a significant predictor of discharge placement after stroke rehabilitation.
To anticipate discharge placement after inpatient rehabilitation, the clinician should consider the age and marital support system of the patient, as well as the functional presentation at admission.