http://journals.lww.com/intjrehabilres/Abstract/publishahead/Stroke_patients_after_neurological_inpatient.99720.aspx
Graessel, Elmar; Schmidt, Ralf; Schupp, Wilfried
Published Ahead-of-Print
We carried out a prospective study to determine whether
stroke patients' functional status or health-related quality of life
would predict whether they lived at home 2.5 years after discharge from
neurological inpatient rehabilitation. We carried out a single-center
prospective cohort study. The outcome 'home care' versus 'death' or
'institutionalization' (nursing home admission) was evaluated 30 months
after discharge. A total of 204 stroke survivors with remaining moderate
to severe functional deficits at admission to neurological inpatient
rehabilitation were included. Clinical data were obtained at admission
to and/or discharge from inpatient rehabilitation. Functional status was
determined using the Barthel Index; health-related quality of life was
assessed using the SF-36 and EQ-5D. The outcome was assessed by
telephone interview. Predictors of living at home were calculated using
binary logistic regression analysis. In total, 30 months after
discharge, 75% of the stroke survivors were still living at home.
Multivariate analysis showed that patients continued to live at home
significantly more frequently when they had fewer mortality-relevant
comorbidities (P=0.001), a higher BMI (P=0.040), a higher increase in
functional independence during inpatient rehabilitation (P=0.017), and
above all, a better health-related quality of life, measured using the
EQ-5D (P<0.001), at discharge. Stroke survivors' health-related
quality of life measured with the EQ-5D and the change in functional
status during multimodal neurological rehabilitation appear to be the
strongest clinically relevant long-term predictors of staying at home.
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