Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

 Rehabilitation success is measured by 100% recovery and since you are not there, you're a complete fucking failure! The tyranny of low expectations(improved functional outcomes) is not acceptable!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! And what is your definition of competence in stroke? Swearing at me is allowed, I'll return the favor. Don't even attempt to use the excuse that brain research is hard.

Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

• Research
• Open access
• Published: 23 January 2025

• Volume 25, article number 126, (2025)
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Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

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• Fan He,
• George Mnatzaganian,
• Michael Njovu,
• David Rutherford,
• Tara Alexander &
• Irene Blackberry 

Abstract

Background

Evidence is limited on the factors influencing successful stroke rehabilitation in regional contexts. Additionally, the relationship between rehabilitation costs following acute stroke, based on Australian National Subacute and Non-Acute Patient (AN-SNAP) casemix classification, and rehabilitation success remains unclear.

Objective

This retrospective cohort study investigated the factors contributing to improved functional outcomes(NOT GOOD ENOUGH! 100% recovery is a successful outcome as demanded by survivors! WHY AREN'T YOU THERE YET?) following stroke rehabilitation in an Australian regional hospital, also evaluating the respective average daily and total payments.

Methods

Stroke patients’ admission records, during 2010–2020, were linked with rehabilitation registry data. Rehabilitation success was defined as relative functional gain (RFG) ≥ 0.5 and Functional Independence Measure (FIM) efficiency ≥ 1. Multivariate mixed effects logistical regressions modelled the sociodemographic and medical (i.e., comorbidities and stroke type) predictors of rehabilitation success, while logarithms of average daily and total rehabilitation payments were modelled using robust regressions.

Results

Of 582 included patients, 315 (54.1%) achieved RFG ≥ 0.5 and 258 (52.2%) achieved FIM efficiency ≥ 1. A longer delay in starting rehabilitation was associated with a lower likelihood of achieving RFG success [Odds Ratio (OR): 0.85, 95% confidence interval (CI): 0.78–0.93, P < 0.001] and FIM efficiency success (OR: 0.89, 95% CI: 0.82–0.97, P = 0.010). A higher FIM score at admission was associated with decreased odds of FIM efficiency success (OR: 0.35, 95% CI: 0.20–0.60, P < 0.001). The average daily and total rehabilitation payments for inpatients were $AU1,255 (median) [interquartile range (IQR): 1,040, 1,771] and $AU28,363 (median) (IQR: 18,822, 41,815), respectively. FIM efficiency success was positively associated with the average daily payment (Beta: 0.25, 95% CI: 0.20–0.30, P < 0.001), but negatively correlated with the total payment (Beta: -0.18, 95% CI: -0.24–0.13, P < 0.001). No significant associations were found between RFG success and these payments.

Conclusion

This study identifies key factors affecting stroke rehabilitation outcomes in a regional Australian setting. Delays in starting rehabilitation were linked to lower success rates, underscoring the importance of timely intervention. While higher average daily costs were associated with better FIM efficiency, total costs did not correlate with relative functional gains. These findings may inform rehabilitation practices and may influence future funding strategies for rehabilitation services.