Barbara E Bates1, Pui L Kwong2, Dawei Xie2, Ali Valimahomed3, Diane Cowper Ripley4, Jibby E Kurichi2, Margaret G Stineman5. 1. Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY. Electronic address: barbara.bates@va.gov. 2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. 3. Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY. 4. Veterans Affairs Medical Center, Gainesville, FL; Division of Health Policy and Outcomes Research, Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL. 5. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVE: To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase. DESIGN: Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters. SETTING: Rehabilitation facilities. PARTICIPANTS: Sample included veterans (N=9681; average age, 68.7y; 97.4% men) diagnosed with new stroke discharged from Veterans Affairs hospitals between October 1, 2006, and September 30, 2008. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Receipt of rehabilitation services. RESULTS: Of the total cohort, 73% received some type of rehabilitation. After adjustment, stroke patients with cerebral arteries occlusion were most likely to receive rehabilitation compared with other stroke types (P<.001). Patients with prestroke conditions of metastatic cancer (odds ratio [OR]=.68, P<.001) and psychosis (OR=.90, P=.045) were less likely to have rehabilitation, whereas those with hypertension (OR=1.26, P<.001) and other neurologic disorders (OR=1.29, P<.001) were more likely. Compared with patients admitted from home, patients transferred from a non-Veterans Affairs hospital (OR=1.4, P<.004) were more likely to receive rehabilitation, whereas patients admitted from extended care (OR=.59, P<.001) were less likely. Married veterans were less likely to receive rehabilitation services (OR=.87, P<.001) than unmarried veterans. CONCLUSIONS: Within the Veterans Health Administration, initiating rehabilitation in the acute phase poststroke appears to be influenced by patient clinical characteristics and living circumstances.
OBJECTIVE: To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase. DESIGN: Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters. SETTING: Rehabilitation facilities. PARTICIPANTS: Sample included veterans (N=9681; average age, 68.7y; 97.4% men) diagnosed with new stroke discharged from Veterans Affairs hospitals between October 1, 2006, and September 30, 2008. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Receipt of rehabilitation services. RESULTS: Of the total cohort, 73% received some type of rehabilitation. After adjustment, strokepatients with cerebral arteries occlusion were most likely to receive rehabilitation compared with other stroke types (P<.001). Patients with prestroke conditions of metastatic cancer (odds ratio [OR]=.68, P<.001) and psychosis (OR=.90, P=.045) were less likely to have rehabilitation, whereas those with hypertension (OR=1.26, P<.001) and other neurologic disorders (OR=1.29, P<.001) were more likely. Compared with patients admitted from home, patients transferred from a non-Veterans Affairs hospital (OR=1.4, P<.004) were more likely to receive rehabilitation, whereas patients admitted from extended care (OR=.59, P<.001) were less likely. Married veterans were less likely to receive rehabilitation services (OR=.87, P<.001) than unmarried veterans. CONCLUSIONS: Within the Veterans Health Administration, initiating rehabilitation in the acute phase poststroke appears to be influenced by patient clinical characteristics and living circumstances.
Authors: Kyu Ho Lee; Min Kyun Sohn; Hye Seon Jeong; Hee Jung Song; Jei Kim; Hyon Jo Kwon; Hyeon Song Koh; Sungju Jee Journal: J Korean Med Sci Date: 2018-03-12 Impact factor: 2.153