Trends in outpatient rehabilitation use for stroke survivors

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Highlights

  • Utilization of outpatient rehabilitation is an expanding healthcare resource in stroke patients.

  • The trend in outpatient utilization for stroke recovery was not influenced by patient insurance type.

  • Over time, there was no gender bias in outpatient rehabilitation utilization in stroke survivors.

Abstract

Background

Stroke survivors with residual disabling deficits who are medically stable may be recommended for acute rehabilitation or outpatient therapy, depending partly on the severity of their deficits. Here we sought to determine if the location at which patients needing rehabilitation post-stroke has shifted from inpatient to an outpatient setting.

Methods

For analysis, we used our Institutional Review Board-approved Get With The Guidelines®-Stroke Database to study stroke survivors discharged to receive either inpatient or outpatient rehabilitation services between 2014 and 2019. Logistic regression analysis was used to identify clinical factors associated with discharge type. Cochran-Armitage trend analysis was used to assess differences in rehabilitation services used over time.

Results

A total of 3293 patients were included. Trend analysis demonstrated a significant increase over time in the proportion of patients needing rehabilitation being discharged home with rehabilitation services (P < 0.0001). In addition, older age was associated with discharge to inpatient rehabilitation (OR = 1.018, 95%CI, 1.011–1.026), as was a higher National Institutes of Health Stroke Scale score (OR = 1.149, 95%CI, 1.130–1.168).

Conclusions

We found that home discharges increased, highlighting outpatient rehabilitation as an expanding healthcare resource for reducing stroke-associated disability in adults.

Introduction

Stroke is the leading cause of long-term rehabilitation use in adults worldwide. [1,2] Although great strides have been made to reduce infarct size disability and death due to stroke, [3,4] many patients report having unmet needs a year or more after discharge from acute stroke care. [5] Furthermore, the prevalence of people living with post-stroke impairment and disability is rising due to the growing aging population, improved survival, [6] and an increasing prevalence among younger adults. [7] Current American Heart Association (AHA)/American Stroke Association guidelines on stroke rehabilitation and recovery advise coordinated efforts by interdisciplinary teams along with patients and their caregivers to ensure optimal outcomes. [8] However, reports demonstrate that rehabilitation services have still been underused for stroke patients specifically, especially in the outpatient setting. [9] Recent studies evaluating trends in the location of rehabilitation for stroke survivors are lacking. We aimed to evaluate the contemporary practices for post-acute healthcare use in our institution by examining the trend in the proportion of stroke survivors with rehabilitation needs being discharged home with outpatient rehabilitation services versus inpatient rehabilitation.

Section snippets

Methods

This study used the University of Florida stroke database obtained from our institutional Get With The Guidelines®-Stroke Database approved by the University of Florida Institutional Review Board. This work represents the authors' independent analysis of local or multicenter data gathered using the Get With The Guidelines® (GWTG) Patient Management ToolTM, but it is not an analysis of the national GWTG dataset and does not represent findings from the AHA GWTG national program. Retrospective

Results

A total of 3293 patients with rehabilitation needs were included in the analysis (Fig. 1 and Table 1). Regression analysis (Table 2) showed that older age was associated with an increased risk of discharge to inpatient rehabilitation (OR = 1.018, 95%CI, 1.011–1.026), as were higher NIHSS scores (OR = 1.149, 95%CI, 1.130–1.168). In 2014, patients had a greater risk of discharge to inpatient rehabilitation than in 2019 (OR = 1.902, 95%CI, 1.400–2.584). This was also the case in 2015 vs 2019

Discussion

The significant increase in the proportion of patients discharged home with rehabilitation services is encouraging because it reflects a trend in patients from our institution being able to receive rehabilitation within a setting that another study has reported could be a patient-preferred setting for rehabilitation when it is medically appropriate. [5] In our study, we specifically opted to study patients that were evaluated and determined to need rehabilitation on hospital discharge, because

Conclusion

Although a significant proportion of patients have received therapy at home, more work is needed to reduce stroke-associated disability in adults.

Sources of funding

None.

Declaration of Competing Interest

None.

References (19)

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