Authors (including presenting author) :
LI KT(1), Ng NP(1), Chan YL(1), Chung SF(1), Yu KK(2)
Affiliation :
(1) Department of Occupational Therapy, Kowloon Hospital (2) Department of Rehabilitation, Kowloon Hospital
Introduction :
This study was confirmed to be published by the Hong Kong Journal of Occupational Therapy.
Stroke is a major cause of disability with an indication for long term rehabilitation, which includes an in-patient phase as well as a community phase.
Early and accurate prediction of rehabilitation outcomes, such as discharge destinations, better functional improvement, etc. can facilitate the rehabilitation team to customize their plans of care (e.g. triage to different wards, intensive training versus reinforcing skills of care-givers, etc.) and allow more time for liaison and/or making referrals between transitions of care. Subsequently, it may improve patients’ outcomes, decrease length of stay, lower costs, and, improve utilization
of resources.
Objectives :
This study explored factors which predict stroke survivors who could achieve “clinically significant functional
gain” and return home when being discharged from a local hospital after in-patient stroke rehabilitation
programme.
Methodology :
This study included 562 inpatients with stroke who were residing at community dwellings before onset of
stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main
outcome variables of prediction were (a) achieving “clinically significant functional gain” as measured by (a1) achievement
of “minimal clinically important difference” (MCID) of improvement in Functional Independence Measure Motor
Measure (FIM-MM)”, (a2) one or more level(s) of improvement in function group as classified by KH according to
the patients’ FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with
univariate binary logistic regression and those significant variables were then put into multivariate binary logistic
regression.
Result & Outcome :
Results: Based on multivariate regression, the significant predictors for “clinically significant functional gain” were:
younger age < 75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, Intermediate KH
FIM-MM function group. Those significant predictors for “discharge to home” were: living with family/caregivers before
stroke, higher FIM score at admission, and one or more level(s) of improvement in KH FIM-MM function group.
Conclusions: This study identified findings consistent with overseas studies in additional to some new interesting
findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to
focus on the use of appropriate intervention strategies and pre-discharge preparation.
