Selecting patients for rehabilitation after acute stroke: are there variations in practice?
OBJECTIVE
To investigate whether there were variations in practice in selection for rehabilitation after stroke, after adjustment for case mix.


METHODS
Prospective multicenter audit.


METHODS
Seven acute stroke units in metropolitan and regional Victoria, Australia.


METHODS
Consecutive acute stroke admissions (N=616).


METHODS
None.


METHODS
Mobility Scale for Acute Stroke Score and Modified Barthel Index (MBI) scores for continence at day 3 poststroke, discharge destination from the acute hospital.


RESULTS
Data were analyzed for 616 stroke survivors. Considerable variability in the percentage of cases accessing inpatient rehabilitation was observed in severe stroke (27%-67%) and mild stroke (27%-73%). To assess adjustment for case mix, a multinomial logistic regression was conducted with the outcome variable being discharge destination (home, rehabilitation, or nursing home), and the predictors being Mobility Scale for Acute Stroke Score, MBI continence scores, age, and social situation. The overall amount of variability explained in discharge destination by the predictors was 63% (Nagelkerke pseudo R(2)). The regression analysis was repeated, adding unit code as a predictor. Unit code was a significant contributor to the model (P<.01).


CONCLUSIONS
The results of the study indicate that, after adjusting for case mix, there may be variations in practice in selection for rehabilitation leading to inequities of access.
Ilett
Paul A
PA
St. Vincent's Hospital, Melbourne, Australia.
Brock
Kim A
KA
Graven
Christine J
CJ
Cotton
Susan M
SM
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D018579:Patient Selection; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012944:Social Support; D000071939:Stroke Rehabilitation; D055815:Young Adult