Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge
DOI:
https://doi.org/10.2340/jrm.v56.19458Keywords:
Stroke, Rehabilitation, Function, IndependenceAbstract
Objective: To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke.
Design: A longitudinal and registry-based study.
Subjects/patients: A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke.
Methods: Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category.
Results: Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence.
Conclusion: Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1–5 years. This may have been due to the less severe nature of these participants’ conditions, compared with those requiring inpatient rehabilitation.
Downloads
References
Langhorne P, Ramachandra S. Organised inpatient (stroke unit) care for stroke: network meta-analysis Cochrane Database Syst Rev 2020; 10. DOI: https://doi.org/10.1002/14651858.CD000197.pub4
https://doi.org10.1002/14651858.CD000197.pub4
Bērziņa G, Vētra A, Sunnerhagen KS. A comparison of stroke rehabilitation; data from two national cohorts. Acta Neurol Scand 2016; 134: 284–291. DOI: https://doi.org/10.1111/ane.12542
https://doi.org10.1111/ane.12542
Langhorne P, Baylan S. Early supported discharge services for people with acute stroke. Cochrane Database Syst Rev 2017; 7: Cd000443. DOI: https://doi.org/10.1002/14651858.CD000443.pub4
https://doi.org10.1002/14651858.CD000443.pub4
Tistad M, Flink M, Ytterberg C, Eriksson G, Guidetti S, Tham K, et al. Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention. BMJ Open 2018; 8: e022222. DOI: https://doi.org/10.1136/bmjopen-2018-022222
https://doi.org10.1136/bmjopen-2018-022222
Wit L, Putman K, Devos H, Brinkmann N, Dejaeger E, Weerdt W, et al. Five-year mortality and related prognostic factors after in-patient stroke rehabilitation: a European multi-centre study. J Rehabil Med 2012; 44: 547–552. DOI: https://doi.org/10.2340/16501977-0991
https://doi.org10.2340/16501977-0991
Vernino S, Brown Jr RD, Sejvar JJ, Sicks JD, Petty GW, O’Fallon MW. Cause-specific mortality after first cerebral infarction: a pop-ulation-based study. Stroke (1970) 2003; 34: 1828–1832. DOI: https://doi.org/10.1161/01.STR.0000080534.98416.A0
https://doi.org10.1161/01.STR.0000080534.98416.A0
Sennfält S, Norrving B, Petersson J, Ullberg T. Long-term survival and function after stroke. Stroke 2019; 50: 53–61. DOI: https://doi.org/10.1161/STROKEAHA.118.022913
https://doi.org10.1161/strokeaha.118.022913
Joundi RA, Smith EE, Yu AYX, Rashid M, Fang J, Kapral MK. Temporal trends in case fatality, discharge destination, and admission to long-term care after acute stroke. Neurology 2021; 96: e2037–e2047. DOI: https://doi.org/10.1212/WNL.0000000000011791
https://doi.org10.1212/wnl.0000000000011791
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–349. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
https://doi.org10.1016/j.jclinepi.2007.11.008
Asplund K, Hulter Åsberg K, Appelros P, Bjarne D, Eriksson M, Johansson Å, et al. The Riks-stroke story: building a sustainable national register for quality assessment of stroke care. Int J Stroke 2011; 6: 99–108. DOI: https://doi.org/10.1111/j.1747-4949.2010.00557.x
https://doi.org10.1111/j.1747-4949.2010.00557.x
Darehed D, Reinholdsson M, Viktorisson A, Abzhandadze T, Stibrant Sunnerhagen K. Death and ADL dependency after scoring zero on the NIHSS: a Swedish retrospective registry-based study. Neurol Clin Pract 2023; 13: e200186. DOI: https://doi.org/10.1212/CPJ.0000000000200186
Labberton A, Barra M, Ronning OM, Thommessen B, Churilov L, Cadilhac D, et al. Patient and service factors associated with refer-ral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway. BMC Health Serv Res 2019; 19: 871. DOI: https://doi.org/10.1186/s12913-019-4713-x
https://doi.org10.1186/s12913-019-4713-x
Glader E, Edlund H, Sukhova M, Asplund K, Norrving B, Eriksson M. More equal stroke unit care over time: a 15-year follow up of socioeconomic disparities in stroke unit care in Sweden. Cerebrovasc Dis 2013; 35: 702–702. DOI: https://doi.org/10.1159/000355497
https://doi.org10.1159/000355497
Asplund K, Sukhova M, Wester P, Stegmayr B. Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals. Stroke 2015; 46: 806–812. DOI: https://doi.org/10.1161/STROKEAHA.114.007212
https://doi.org10.1161/strokeaha.114.007212
Willers C, Lekander I, Ekstrand E, Lilja M, Pessah-Rasmussen H, Sunnerhagen KS, et al. Sex as predictor for achieved health out-comes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ 2018; 9: 11. DOI: https://doi.org/10.1186/s13293-018-0170-1
https://doi.org10.1186/s13293-018-0170-1
Textor J, Hardt J, Knüppel S. DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology (Cambridge, Mass) 2011; 22: 745–745. DOI: https://doi.org/10.1097/EDE.0b013e318225c2be
https://doi.org10.1097/EDE.0b013e318225c2be
Fagerland MW, Hosmer DW. Tests for goodness of fit in ordinal logistic regression models. J Stat Comput Simul 2016; 86: 3398–3418. DOI: https://doi.org/10.1080/00949655.2016.1156682
https://doi.org10.1080/00949655.2016.1156682
Van Calster B, Van Belle V, Vergouwe Y, Steyerberg EW. Discrimination ability of prediction models for ordinal outcomes: relation-ships between existing measures and a new measure: discrimination ability of prediction models for ordinal outcomes. Biom J 2012; 54: 674–685. DOI: https://doi.org/10.1002/bimj.201200026
https://doi.org10.1002/bimj.201200026
Spedicato GA. Discrete Time Markov Chains with R. R Foundation for Statistical Computing; 2017. DOI: https://doi.org/10.32614/RJ-2017-036
Shah VA, Thompson RE, Yenokyan G, Acosta JN, Avadhani R, Dlugash R, et al. One-year outcome trajectories and factors associat-ed with functional recovery among survivors of intracerebral and intraventricular hemorrhage with initial severe disability. JAMA Neurol 2022; 79: 856–868; DOI: 10.1001/jamaneurol.2022.1991 DOI: https://doi.org/10.1001/jamaneurol.2022.1991
García-Rudolph A, Saurí J, Cegarra B, Madai VI, Frey D, Kelleher JD, et al. Long-term trajectories of motor functional independence after ischemic stroke in young adults: identification and characterization using inpatient baseline assessments. NeuroRehabili-tation 2022; 50: 453–465. DOI: https://doi.org/10.3233/NRE-210293
https://doi.org10.3233/nre-210293
National Board of Health and Welfare. National guidelines on stroke care [in Swedish]. [Accessed February 22, 2023]. Available from: https://www.socialstyrelsen.se/regler-och-riktlinjer/nationella-riktlinjer/riktlinjer-och-utvarderingar/stroke/.
Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new stan-dards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable Taskforce. Neurorehabil Neural Repair 2017; 31: 793–799. DOI: https://doi.org/10.1177/1545968317732668
https://doi.org10.1177/1545968317732668
Bunketorp Käll L, Lundgren Nilsson Å, Samuelsson H, Pekny T, Blomvé K, Pekna M, et al. Long-term improvements after multimodal rehabilitation in late phase after stroke: a randomized controlled trial. Stroke 2017; 48: 1916-1924.
https://doi.org/10.1161/STROKEAHA.116.016433 DOI: https://doi.org/10.1161/STROKEAHA.116.016433
Teasell RW, Foley NC, Bhogal SK, Chakravertty R, Bluvol A. A rehabilitation program for patients recovering from severe stroke. Can J Neurol Sci 2005; 32: 512–517. DOI: https://doi.org/10.1017/S0317167100004534
https://doi.org10.1017/s0317167100004534
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke (1970) 2016; 47: e98. DOI: https://doi.org/10.1161/STR.0000000000000098
https://doi.org10.1161/STR.0000000000000098
National knowledge based clinical recommendations. Stroke and TIA – Continuous nursing and rehabilitation [in Swedish]. [Accessed Feb 2, 2024. cited Feb 2, 2024]. Available from: https://www.nationelltklinisktkunskapsstod.se/Stockholm/kunskapsstod/vardforlopp/?uuid = 82dfd977-0bf9-4dad-b472-468cf77acce3]
Eriksson M, Appelros P, Norrving B, Terent A, Stegmayr B. Assessment of functional outcome in a national quality register for acute stroke: can simple self-reported items be transformed into the modified Rankin scale? Stroke (1970) 2007; 38: 1384–1386. DOI: https://doi.org/10.1161/01.STR.0000260102.97954.9c
https://doi.org10.1161/01.STR.0000260102.97954.9c
Abzhandadze T, Reinholdsson M, Palstam A, Eriksson M, Sunnerhagen KS. Transforming self-reported outcomes from a stroke register to the modified Rankin Scale: a cross-sectional, explorative study. Sci Rep 2020; 10: 17215–17215. DOI: https://doi.org/10.1038/s41598-020-73082-4
https://doi.org10.1038/s41598-020-73082-4
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of ac-ute cerebral infarction: a clinical examination scale. Stroke 1989; 20: 864–870. DOI: https://doi.org/10.1161/01.STR.20.7.864
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Malin C. Nylén, Tamar Abzhandadze, Hanna C. Persson, Katharina S. Sunnerhagen
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.