Abstract
Background
Some
clinical features of patients after stroke may be modifiable and used
to predict outcomes. Identifying these features may allow for refining
plans of care and informing estimates of posthospital service needs. The
purpose of this study was to identify key factors that predict
functional independence and living setting 3 months after rehabilitation
hospital discharge by using a large comprehensive national data set of
patients with stroke.
Methods
The
Uniform Data System for Medical Rehabilitation was queried for the
records of patients with a diagnosis of stroke who were hospitalized for
inpatient rehabilitation from 2005 through 2007. The system includes
demographic, administrative, and clinical variables collected at
rehabilitation admission, discharge, and 3-month follow-up. Primary
outcome measures were the Functional Independence Measure score and
living setting 3 months after rehabilitation hospital discharge.
Results
The
sample included 16,346 patients (80% white; 50% women; mean [SD] age,
70.3 [13.1] years; 97% ischemic stroke). The strongest predictors of
Functional Independence Measure score and living setting at 3 months
were those same factors at rehabilitation discharge, despite considering
multiple other predictor variables including age, lesion laterality,
initial neurologic impairment, and stroke-related comorbid conditions.
Conclusions
These
data can inform clinicians, patients with stroke, and their families
about what to expect in the months after hospital discharge. The
predictive power of these factors, however, was modest, indicating that
other factors may influence postacute outcomes. Future predictive
modeling may benefit from the inclusion of educational status,
socioeconomic factors, and brain imaging to improve predictive power.
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