TY - JOUR
T1 - Increased Relative Functional Gain and Improved Stroke Outcomes
T2 - A Linked Registry Study of the Impact of Rehabilitation
AU - Mosalski, Simon
AU - Shiner, Christine T.
AU - Lannin, Natasha A.
AU - Cadilhac, Dominique A.
AU - Faux, Steven G.
AU - Kim, Joosup
AU - Alexander, Tara
AU - Breen, Sibilah
AU - Nilsson, Michael
AU - Pollack, Michael
AU - Bernhardt, Julie
AU - Simmonds, Frances
AU - Dewey, Helen M.
AU - Grimley, Rohan
AU - Hillier, Susan
AU - Kilkenny, Monique F.
N1 - Funding Information:
This study was funded by a stipend within the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery grant. The Australian Stroke Clinical Registry (AuSCR) received funding from a range of government, non-government and industry sources. The following authors receive Research Fellowship support from the NHMRC: Drs Kilkenny (1109426), Lannin (1112158), and Cadilhac (1154273 co-funded by Heart Foundation).
Funding Information:
Prof Cadilhac is the current Data Custodian for the Australian Stroke Clinical Registry (AuSCR). Professors Cadilhac, Lannin, Faux and A/Prof Kilkenny are members of the AuSCR Steering or Management Committees. Prof Cadilhac reported receiving restricted grants from Boerhinger Ingelheim, Ipsen, Medtronic and Shire outside the submitted work. Ms Simmonds was the Director of the Australasian Rehabilitation Outcomes Centre (AROC), and Ms Alexander is the AROC Database Manager and Statistician.
Funding Information:
We acknowledge members of the Australian Stroke Clinical Registry (AuSCR) Management/Steering Committee, staff from the George Institute for Global Health and the Florey Institute of Neuroscience and Mental Health who manage the AuSCR (online-only Data Supplement). We also thank the hospital clinicians (online-only Data Supplement) and patients who contribute data to the AuSCR and the staff from AROC member facilities who collect and submit the AROC data. This study was funded by a stipend within the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery grant. The Australian Stroke Clinical Registry (AuSCR) received funding from a range of government, non-government and industry sources. The following authors receive Research Fellowship support from the NHMRC: Drs Kilkenny (1109426), Lannin (1112158), and Cadilhac (1154273 co-funded by Heart Foundation). Prof Cadilhac is the current Data Custodian for the Australian Stroke Clinical Registry (AuSCR). Professors Cadilhac, Lannin, Faux and A/Prof Kilkenny are members of the AuSCR Steering or Management Committees. Prof Cadilhac reported receiving restricted grants from Boerhinger Ingelheim, Ipsen, Medtronic and Shire outside the submitted work. Ms Simmonds was the Director of the Australasian Rehabilitation Outcomes Centre (AROC), and Ms Alexander is the AROC Database Manager and Statistician.
Publisher Copyright:
© 2021 Elsevier Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
KW - Data linkage
KW - Health data
KW - Population register
KW - Registry
KW - Rehabilitation
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85111612418&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2021.106015
DO - 10.1016/j.jstrokecerebrovasdis.2021.106015
M3 - Article
C2 - 34340054
AN - SCOPUS:85111612418
SN - 1052-3057
VL - 30
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 10
M1 - 106015
ER -