Factors Predicting Discharge Disposition after Sub-acute Stroke Rehabilitation

Abstract

<p>A variety of factors influence discharge disposition post stroke, but the effects of many variables are still controversial and there is scarce information on part of the possible predictors. A better comprehension of the factors associated with discharge disposition may help to establish more realistic and tailored treatments, and a better preparation of the rehabilitants and significant others for the transition from hospital to community or institution. In this observational cohort study of 229 consecutive subacute stroke rehabilitants, 28.5% were discharged home without service, 37.1% with service and 34.5% were discharged to institutional care. The rehabilitants institutionalized were oldest, had the highest stroke and disease severity and disability, most comorbidities and the longest time from stroke onset to rehabilitation admission. Those discharged home without service were youngest, most often still working and they had the shortest length of stay, and the mildest stroke severity and disability. The subgroup discharged home with service had significantly higher functional improvement than those institutionalized despite equal length of rehabilitation in-stay. In bivariate analysis, a number of clinical, functional and demographic variables were associated with discharge disposition. In regression analysis, the most influential predictors for discharge disposition towards increasing support or institutionalization were higher age, lower admission FIM scores in sphincter control, locomotion and cognition, lower FIM gain during the rehabilitation in-stay, higher severity of neglect and acute phase dysphagia/ feeding tube.<br /></p>