Use of a Standardized Assessment to Predict Rehabilitation Care After Acute Stroke

Abstract Objective To pilot a program of formal assessment of rehabilitation needs and predictors of referral to rehabilitation. Design A prospective pilot project to collect standardized measures of stroke severity and function: National Institutes of Health Stroke Scale, premorbid modified Rankin scale, Short Portable Mental Status Questionnaire, and Barthel Index (BI). These were collected in addition to routine data in the Get With The Guidelines-Stroke registry. Logistic regression was used to examine predictors of referral to any institution-based rehabilitation versus discharge home and referral to an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF). Setting Twenty-two hospitals within the Northeast Cerebrovascular Consortium (located in the northeastern United States). Participants Data were collected on individuals with acute ischemic and hemorrhagic stroke (N=736). Interventions Not applicable. Main Outcome Measures Discharge disposition location. Results The BI score was recorded in 736 (81%) patients. In multivariable analyses, a higher BI score (85–100) was the only factor associated with return home versus need for institution-based rehabilitation ( P P P =.004) and more likely in those with moderate-severe (BI score, 25–40; OR, 3.26; CI, 1.45–7.30; P =.004) or moderate (BI score, 45–60; OR, 2.47; CI, 1.17–5.21; P =.018) activities of daily living (ADL) impairment. Conclusions Formal standardized assessment of rehabilitation needs was feasible in this pilot project. Patients' sociodemographic characteristics, premorbid function, and ADL impairment discriminated better between discharge home and institution-based rehabilitation than between IRF and SNF. Selection of IRF versus SNF appears to be influenced either by unmeasured clinical characteristics of individuals with stroke or by nonclinical factors, such as cost, geography, referral relationships, or IRF availability.