Geriatric Rehabilitation After Stroke: Is Condition on Admission Indicative for Discharge Destination?

Buijck, Bianca Ivonne

Purpose:

In the past decade, there has been increasing interest in stroke rehabilitation. Worldwide, every year more than 15 million people suffer a stroke. The expectation is that the number of patients with stroke will rise in the future, because of the ageing of the population. Consequently, there will be a growing demand for rehabilitation services. Therefore, the aim of this study was to investigate the condition on admission of patients after a stroke and the course of their rehabilitation in order to develop rehabilitation programs.

Methods:

This study is a longitudinal, multicenter, observational study. Data were collected on patient characteristics, comorbidity (Charlson Index), ADL (Barthel Index), arm function (Frenchay Arm Test), balance (Berg Balance Scale), walking (FAC score), neuropsychiatric symptoms (Neuropsychiatric Inventory: Nursing Home), depression (Geriatric Depression Scale). All measurements were performed on admission and at discharge. A cluster-analysis was used to reveal meaningful groups.

Results:

One –hundred- twenty- seven patients participated in this study. Patients improved in balance, walking abilities, and arm function. A total of 84 patients (66%) were discharged to an independent/assisted-living situation, and 43 (34%) were referred for long-term care to a nursing home. Using cluster analysis, with relevant patient characteristics (age, gender, stroke type, first stroke, localization stroke), balance, arm function, walking abilities, activities of daily living, depressive complaints and neuropsychiatric symptoms, it was possible to identify two clusters of patients: those in fair/good condition on admission and those in poor condition on admission.

Conclusion:

Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Rehabilitation programs that provide algorithms for multidisciplinary collaboration and evaluation on the basis of continuous monitoring of the physical and psychological condition of patients can be helpful in providing optimal individually tailored rehabilitation care.