Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.
OBJECTIVE
The purpose of this study was to determine if compliance with poststroke rehabilitation guidelines was associated with better functional outcomes.


METHODS
An inception cohort of 288 stroke patients in 11 Department of Veteran Affairs Medical Centers hospitalized between January 1998 and March 1999 were followed prospectively for 6 months. Data were abstracted from medical records and telephone interviews. The primary study outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and postacute rehabilitation guideline compliance scores (range 0 to 100) were derived from an algorithm. All outcomes were adjusted for case-mix.


RESULTS
Average compliance scores in acute and postacute care settings were 68.2% (SD 14) and 69.5% (SD 14.4), respectively. After case-mix adjustment, level of compliance with postacute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function was not associated with guideline compliance. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures.


CONCLUSIONS
Greater levels of adherence to postacute stroke rehabilitation guidelines were associated with improved patient outcomes. Compliance with guidelines may be viewed as a quality-of-care indicator with which to evaluate new organizational and funding changes involving postacute stroke rehabilitation.
Duncan
Pamela W
PW
Kansas City VA Medical Center and Center on Aging, The University of Kansas Medical Center, Kansas City 66160-7117, USA. pduncan@kumc.edu
Horner
Ronnie D
RD
Reker
Dean M
DM
Samsa
Gregory P
GP
Hoenig
Helen
H
Hamilton
Byron
B
LaClair
Barbara J
BJ
Dudley
Tara K
TK
D000203:Activities of Daily Living / Q000145:classification; D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014481:United States