Increased Relative Functional Gain and Improved Stroke Outcomes: A Linked Registry Study of the Impact of Rehabilitation

Simon Mosalski; Christine T Shiner; Natasha A Lannin; Dominique A Cadilhac; Steven G Faux; Joosup Kim; Tara Alexander; Sibilah Breen; Michael Nilsson; Michael Pollack; Julie Bernhardt; Frances Simmonds; Helen M Dewey; Rohan Grimley; Susan Hillier; Monique F Kilkenny

doi:10.1016/j.jstrokecerebrovasdis.2021.106015

Increased Relative Functional Gain and Improved Stroke Outcomes: A Linked Registry Study of the Impact of Rehabilitation

J Stroke Cerebrovasc Dis. 2021 Oct;30(10):106015. doi: 10.1016/j.jstrokecerebrovasdis.2021.106015. Epub 2021 Jul 31.

Authors

Simon Mosalski¹, Christine T Shiner², Natasha A Lannin³, Dominique A Cadilhac⁴, Steven G Faux¹, Joosup Kim⁴, Tara Alexander⁵, Sibilah Breen⁶, Michael Nilsson⁷, Michael Pollack⁷, Julie Bernhardt⁶, Frances Simmonds⁵, Helen M Dewey⁸, Rohan Grimley⁹, Susan Hillier¹⁰, Monique F Kilkenny¹¹

Affiliations

¹ Department of Rehabilitation, St Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Sydney Campus, The University of Notre Dame, Australia.
² Department of Rehabilitation, St Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
³ Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
⁴ Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia; Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia.
⁵ Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, NSW, Australia.
⁶ Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
⁷ Centre for Rehab Innovations, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁸ Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.
⁹ Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia; Sunshine Coast Clinical School, Griffith University, Birtinya, QLD, Australia.
¹⁰ Division of Health Sciences, University of South Australia, SA, Australia.
¹¹ Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia; Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia. Electronic address: Monique.kilkenny@monash.edu.

PMID: 34340054
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106015

Abstract

Objectives: It is unclear how acute care influences patient outcomes in those who receive rehabilitation. We aimed to determine the associations between acute stroke therapies, outcomes during inpatient rehabilitation and self-reported outcomes at 90-180 days after stroke.

Materials and methods: Patient-level data from adults with acute stroke registered in the Australian Stroke Clinical Registry (AuSCR, 2014-2017) were linked with data from the Australasian Rehabilitation Outcomes Centre (AROC). The main outcome was relative function gain (RFG), which is a measure of the FIM change achieved between admission to discharge as a proportion of the total gain possible based on admission FIM, relative to the maximum achievable score. Multilevel logistic/median regression analyses were used to investigate the association between RFG achieved in rehabilitation and (1) acute stroke therapies; (2) 90-180 day outcomes (health-related quality of life using EuroQoL-5D-3L; independence according to modified Rankin Scale (score 0-2) and self-reported hospital readmission).

Results: Overall, 8397/8507 eligible patients from the AuSCR were linked with corresponding AROC data (95% linkage rate; median age 75 years, 43% female); 4239 had 90-180 days survey data. Receiving thrombolysis (16% of the cohort) had a minimal association with RFG in rehabilitation (coefficient: 0.03; 95% Confidence Interval [CI]: 0.01, 0.05). Greater RFG achieved whilst in in-patient rehabilitation was associated with better longer-term HR-QoL (coefficient 21.77, 95% CI 17.8, 25.8) including fewer problems with mobility, self-care, pain, usual activities and anxiety/depression; greater likelihood of independence (adjusted Odds Ratio: 10.66; 95% CI 7.86, 14.45); and decreased odds of self-reported hospital readmission (adjusted Odds Ratio: 0.53; 95% CI 0.41, 0.70) within 90-180 days post-stroke.

Conclusions: Stroke survivors who achieved greater RFG during inpatient rehabilitation had better HR-QoL and were more likely to be independent at follow-up. Acute care processes did not appear to impact RFG or long-term outcomes for those who accessed inpatient rehabilitation.

Keywords: Data linkage; Health data; Population register; Registry; Rehabilitation; Stroke.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Australia
Disability Evaluation
Female
Functional Status*
Humans
Male
Middle Aged
Patient Admission
Patient Readmission
Patient Reported Outcome Measures
Quality of Life
Recovery of Function
Registries
Retrospective Studies
Stroke / diagnosis
Stroke / physiopathology
Stroke / therapy*
Stroke Rehabilitation*
Time Factors
Treatment Outcome