RELATIONSHIP BETWEEN LENGTH OF STAY FOR REHABILITATION AND FUNCTIONAL OUTCOMES IN STROKE PATIENTS
DOI:
https://doi.org/10.21776/ub.mnj.2023.009.01.1Keywords:
Length of stay, Neurological rehabilitation, Rehabilitation outcome, Stroke, Treatment efficacyAbstract
Background: The comorbidities, age and disability of the stroke patients may influence the rehabilitation period. In the rehabilitation process of stroke patients, the length of stay in hospital is important because of its economic and psychological effects.
Objective: The purpose of this study was to evaluate whether there is a relationship between the length of hospital stay for rehabilitation and functional outcomes of stroke patients.
Methods: The medical records of 97 patients who were admitted to a rehabilitation unit were analyzed retrospectively. The functional output, the level of spasticity, and motor development at admission and discharge were determined using the Functional Independence Measure instrument, the Modified Ashworth Scale, and the Brunnstrom test, respectively. Based on the length of hospital stay, patients were divided into two groups: hospital stays ≤ 3 months (Group 1) and > 3 months (Group 2). Clinical features and functional output were then compared between the groups.
Results: The gain of Functional Independence Measure instrument -total and Functional Independence Measure instrument-motor scores were significantly higher in Group 1 (n=74) (p < 0.05) than Group 2 (n=23). The Modified Ashworth Scale scores of the upper extremities and of the lower extremities at admission and discharge were significantly higher in Group 2 (p < 0.05 for all).
Conclusion: The findings of this study revealed that a prolonged length of hospital stay has no greater positive effect on improvement of functional outcomes and spasticity of stroke patients.
Downloads
References
Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The stroke data bank: Design, methods, and baseline characteristics. Stroke; 1988. 19(5):547-554.
DOI: 10.1161/01.str.19.5.547
Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: advancing our understanding of disease mechanism and therapy. Neurotherapeutics; 2011. Jul;8(3):319-29. DOI: 10.1007/s13311-011-0053-1
Santus G, Ranzenigo A, Caregnato R, Inzoli MR. Social and family integration of hemiplegic elderly patients 1 year after stroke. Stroke; 1990. 21(7):1019-1022. DOI: 10.1161/01.str.21.7.1019
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association [published correction appears in Stroke; 2017. Feb;48(2):e78] [published correction appears in Stroke. 2017 Dec;48(12 ):e369]. Stroke; 2016. 47(6):e98-e169.
DOI 10.1161/STR.0000000000000098
Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke; 2016. 11(4):459-484. DOI: 10.1177/1747493016643553
Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: Results of a WHO collaborative study. Bull World Health Organ; 1980. 58(1):113-30. PMID: 6966542; PMCID: PMC2395897.
Bindawas SM, Vennu V, Mawajdeh H, Alhaidary HM, Moftah E. Length of stay and functional outcomes among patients with stroke discharged from an inpatient rehabilitation facility in Saudi Arabia. Med Sci Monit; 2018. Jan 11;24:207-214.
DOI: 10.12659/msm.907452.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis; 1987. 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. PMID: 3558716
Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil; 1994. Feb;75(2):127-32. PMID: 8311667
Yavuzer G, Suldur N, Kucukdeveci A, Elhan A. The role of functional independence measure and Modified Barthel Index in the assessment of neurorehabilitation patients in Turkey. J Rheum Med Rehab 2000; 11:26-31.
Brunnstrom S. Motor testing procedures in hemiplegia: Based on sequential recovery stages. Phys Ther; 1966. 46(4):357-375. DOI: 10.1093/ptj/46.4.357
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther; 1987. 67(2):206-207. DOI: 10.1093/ptj/67.2.206
Kim BR, Lee J, Sohn MK, Kim DY, Lee SG, Shin YI, et al. Risk Factors and Functional Impact of Medical Complications in Stroke. Ann Rehabil Med; 2017. 41(5):753-760. DOI: 10.5535/arm.2017.41.5.753
Watson JC, Sandroni P. Central Neuropathic Pain Syndromes. Mayo Clin Proc; 2016. 91(3):372-385. DOI: 10.1016/j.mayocp.2016.01.017
Balaban B, Tok F, Yavuz F, Yaşar E, Alaca R. . Early rehabilitation outcome in patients with middle cerebral artery stroke. Neurosci Lett; 2011. 498(3):204-207. DOI: 10.1016/j.neulet.2011.05.009
Ottenbacher KJ, Jannell S. The results of clinical trials in stroke rehabilitation research. Arch Neurol; 1993. 50(1):37-44.
DOI: 10.1001/archneur.1993.00540010033014
Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (AVERT):
Phase II safety and feasibility. Stroke; 2008 Feb;39(2):390-6.
DOI: 10.1161/STROKEAHA.107.492363.
Cumming TB, Thrift AG, Collier JM, Churilov L, Dewey HM, Donnan GA, et al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial. Stroke; 2011. 42(1):153-158.
DOI: 10.1161/STROKEAHA.110.594598
Salter K, Jutai J, Hartley M, Foley N, Bhogal S, Bayona N, et al. Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. J Rehabil Med; 2006. 38(2):113-117.
DOI: 10.1080/16501970500314350
Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P, et al. Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil; 2000. 81(6):695-700. DOI: 10.1016/s0003-9993(00)90095-9
Zorowitz RD, Gillard PJ, Brainin M. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology; 2013. 80(3 Suppl 2):S45-S52. DOI: 10.1212/WNL.0b013e3182764c86
Balakrishnan S, Ward AB. The diagnosis and management of adults with spasticity. Handb Clin Neurol; 2013. 110:145-160. DOI: 10.1016/B978-0-444-52901-5.00013-7
Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: A prospective, observational trial. J Neurol; 2010. 257(7):1067-1072. DOI: 10.1007/s00415-010-5463-1
Opheim A, Danielsson A, Alt Murphy M, Persson HC, Sunnerhagen KS. Upper-limb spasticity during the first year after stroke: Stroke arm longitudinal study at the University of Gothenburg. Am J Phys Med Rehabil; 2014. 93(10):884-896.
DOI: 10.1097/PHM.0000000000000157
Welmer AK, Widén Holmqvist L, Sommerfeld DK. Location and severity of spasticity in the first 1-2 weeks and at 3 and 18 months after stroke. Eur J Neurol; 2010. 17(5):720-725. DOI: 10.1111/j.1468-1331.2009.02915.x
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Malang Neurology Journal

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.