Factors influencing receipt of early rehabilitation after stroke

Abstract

Objective: To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase.

Design: Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters.

Setting: Rehabilitation facilities.

Participants: Sample included veterans (N=9681; average age, 68.7y; 97.4% men) diagnosed with new stroke discharged from Veterans Affairs hospitals between October 1, 2006, and September 30, 2008.

Interventions: Not applicable.

Main outcome measure: Receipt of rehabilitation services.

Results: Of the total cohort, 73% received some type of rehabilitation. After adjustment, stroke patients with cerebral arteries occlusion were most likely to receive rehabilitation compared with other stroke types (P<.001). Patients with prestroke conditions of metastatic cancer (odds ratio [OR]=.68, P<.001) and psychosis (OR=.90, P=.045) were less likely to have rehabilitation, whereas those with hypertension (OR=1.26, P<.001) and other neurologic disorders (OR=1.29, P<.001) were more likely. Compared with patients admitted from home, patients transferred from a non-Veterans Affairs hospital (OR=1.4, P<.004) were more likely to receive rehabilitation, whereas patients admitted from extended care (OR=.59, P<.001) were less likely. Married veterans were less likely to receive rehabilitation services (OR=.87, P<.001) than unmarried veterans.

Conclusions: Within the Veterans Health Administration, initiating rehabilitation in the acute phase poststroke appears to be influenced by patient clinical characteristics and living circumstances.

Keywords: CI; CNS; FSOD; Functional Status and Outcome Database; ICD-9-CM; International Classification of Diseases, 9th Revision, Clinical Modification; OR; PFT; Patient Treatment File; Rehabilitation; Stroke; VAMC; VHA; Veterans; Veterans Affairs Medical Center; Veterans Health Administration; central nervous system; confidence interval; odds ratio.