Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Predictors of Functional Change in Stroke Patients Participating in an Early Supported Discharge Program (105375)

Renita Manning 1 , Sabrina Hernandez 2 , Nicholas Taylor 3 4
  1. Early Stroke Discharge Program, Eastern Health, Burwood East, Victoria, Australia
  2. Physiotherapy, Eastern Health, Burwood East, Victoria, Australia
  3. Allied Health Clinical Research Office, Eastern Health, Boxhill, Victoria, Australia
  4. School of Allied Health Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia

Introduction

Early Supported Discharge (ESD) programs, delivered in the community, are strongly recommended for patients post-stroke1,2. The aim of this study was to determine clinical and service factors associated with functional improvement in patients admitted to an ESD program. 

Methods

A retrospective cohort design of stroke patients admitted to an ESD program over one year. For univariate analysis, demographic, clinical and health service factors were compared between those achieving a minimally clinically important difference (MCID) of change in Functional Independence Measure3 (FIM) score >22 by ESD discharge, with those that did not (MCID≤22). Factors that were significantly different in the univariate analysis were entered into a standard multiple regression to identify variables independently associated with improvement in FIM total and FIM mobility scores. 

Results

Of the 128 patients, mean age was 69.1 years, 61% were males and 98% were independently walking pre-stroke. The mean time from stroke to ESD admission was 33.2 days. Longer ESD length of stay, higher number of clinical contacts, increased time since stroke and referral from inpatient rehabilitation were associated with increased likelihood of achieving a MCID in FIM score. In multiple regression analysis, the variables that made an independent contribution to change in FIM mobility were time since stroke, type of ESD model of care, number of physiotherapy contacts and admission FIM mobility score (Beta=-0.366). Only increased total number of clinical contacts was independently associated with improvement in total FIM score. Most patients were discharged from ESD with slight disability (modified Rankin Scale score 2). 

Conclusion

Receiving a more intensive ESD program was associated with greater improvement in overall function, even if entering the program following a subacute inpatient admission. 

Relevance to clinical practice

Intensive home-based rehabilitation should be considered in both the early and later subacute phases post-stroke where ongoing functional improvements are demonstrated.

  1. 1. Fisher, R., Gaynor, C., Kerr, M., Langhorne, P., Anderson, C., Bautz-Holter, E., Indreda:vik, B., Mayo, N., Power, M., Rodgers, H., Ronning, O., Holmqvist, L., Wolfe, C., Walker, M. A Consensus on Stroke Early Supported Discharge. Stroke. 2011; 42:1392-1397
  2. 2. Langhorne P, Baylan S. Early Supported Discharge Triallists. Early Supported Discharge Services for People with Acute Stroke. Cochrane Database Syst Rev 2017;7:CD000443
  3. 3. Deutsch, A., Braun, S., & Granger, C. The Functional Independence Measure (FIMSM Instrument) and the Functional Independence Measure for Children (WeeFIM® Instrument): Ten Years of Development. Critical Reviews in Physical and Rehabilitation Medicine, 1996: 8(4), 267-281