Carmen E Capo-Lugo1, Robert L Askew2, Kathryn Muldoon3, Matthew Maas3, Eric Liotta3, Shyam Prabhakaran4, Andrew Naidech3. 1. Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: capolugo@uab.edu. 2. Department of Psychology, Stetson University, DeLand, Florida. 3. Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston. 4. Department of Neurology, The University of Chicago, Chicago, Illinois.
Abstract
OBJECTIVE: Assess the association of time to initiation of acute rehabilitation therapy with disability after intracerebral hemorrhage (ICH) and identify predictors of time to initiation of rehabilitation therapy. DESIGN: Retrospective data analysis of prospectively collected data from an ongoing observational cohort study. SETTING: Large comprehensive stroke center in a metropolitan area. PARTICIPANTS: Adults with ICH consecutively admitted (n=203). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as the number of days between hospital admission and the first consult by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy, speech therapy). RESULTS: The median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 (range=2-7). Multivariable logistic regression models indicated that each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome at 30 days (adjusted odds ratio [OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify the predictors of time to initiation of rehabilitation therapy identified heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism, and longer length of stay in the intensive care unit as independent predictors of later initiation of acute rehabilitation therapy. CONCLUSIONS: Longer time to initiation of acute rehabilitation therapy after ICH may have persistent effects on poststroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.
OBJECTIVE: Assess the association of time to initiation of acute rehabilitation therapy with disability after intracerebral hemorrhage (ICH) and identify predictors of time to initiation of rehabilitation therapy. DESIGN: Retrospective data analysis of prospectively collected data from an ongoing observational cohort study. SETTING: Large comprehensive stroke center in a metropolitan area. PARTICIPANTS: Adults with ICH consecutively admitted (n=203). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as the number of days between hospital admission and the first consult by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy, speech therapy). RESULTS: The median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 (range=2-7). Multivariable logistic regression models indicated that each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome at 30 days (adjusted odds ratio [OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify the predictors of time to initiation of rehabilitation therapy identified heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism, and longer length of stay in the intensive care unit as independent predictors of later initiation of acute rehabilitation therapy. CONCLUSIONS: Longer time to initiation of acute rehabilitation therapy after ICH may have persistent effects on poststroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.
Authors: Claire J Tipping; Meg Harrold; Anne Holland; Lorena Romero; Travis Nisbet; Carol L Hodgson Journal: Intensive Care Med Date: 2016-11-18 Impact factor: 17.440
Authors: Andrew M Naidech; Jennifer L Beaumont; Neil F Rosenberg; Matthew B Maas; Adam R Kosteva; Michael L Ault; David Cella; E Wesley Ely Journal: Am J Respir Crit Care Med Date: 2013-12-01 Impact factor: 21.405