Deans' stroke musings: Use of a standardized assessment to predict rehabilitation care after acute stroke

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.

Wednesday, May 13, 2015

Use of a standardized assessment to predict rehabilitation care after acute stroke

This is not really worthwhile data since currently there is no objective basis for classifying damage. Standardized measures of stroke severity and function do not correlate to any measurement of cubic cm. of dead brain and its location or any measure of penumbra damage. Until we get to size and location to describe stroke damage we can't make any comparisons at all.
http://search.naric.com/research/rehab/redesign_record.cfm?search=2&type=all&criteria=J70666&phrase=no&rec=127089

Archives of Physical Medicine and Rehabilitation , Volume 96(2) , Pgs. 210-217.

NARIC Accession Number: J70666. What's this?
ISSN: 0003-9993.
Author(s): Stein, Joel; Bettger, Janet P.; Sicklick, Alyse; Hedeman, Robin; Magdon-Ismail, Zainab; Schwamm, Lee H..
Publication Year: 2015.
Number of Pages: 8.
Abstract: Study implemented a formal assessment of rehabilitation needs that included standardized measures of function and sociodemographic factors known to influence referral and utilization of rehabilitation after an acute stroke. The following standardized measures of stroke severity and function were collected on 736 individuals with acute ischemic and hemorrhagic stroke: National Institutes of Health Stroke Scale, premorbid modified Rankin scale, Short Portable Mental Status Questionnaire, and Barthel Index (BI). These were collected in addition to routine data in the Get With The Guidelines-Stroke registry. The main outcome of interest was discharge disposition location. Logistic regression was used to examine predictors of referral to any institution-based rehabilitation versus discharge home and referral to an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF). In multivariable analyses, a higher BI score (85-100) was the only factor associated with return home versus need for institution-based rehabilitation. Among patients discharged to IRF versus SNF, discharge to IRF was less likely in older patients and in those with prestroke disability and more likely in those with moderate-severe (BI score 25-40) or moderate (BI score, 45-60) activities of daily living (ADL) impairment. Formal standardized assessment of rehabilitation needs was feasible in this pilot project. Patients’ sociodemographic characteristics, premorbid function, and ADL impairment discriminated better between discharge home and institution-based rehabilitation than between IRF and SNF. Selection of IRF versus SNF appears to be influenced either by unmeasured clinical characteristics of individuals with stroke or by nonclinical factors, such as cost, geography, referral relationships, or IRF availability.
Descriptor Terms: FEASIBILITY STUDIES, MEASUREMENTS, NEEDS ASSESSMENT, OUTCOMES, REHABILITATION, STROKE.

Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Stein, Joel, Bettger, Janet P., Sicklick, Alyse, Hedeman, Robin, Magdon-Ismail, Zainab, Schwamm, Lee H.. (2015). Use of a standardized assessment to predict rehabilitation care after acute stroke. Archives of Physical Medicine and Rehabilitation, 96(2), Pgs. 210-217. Retrieved 5/13/2015, from REHABDATA database.