title: Trade-offs between effectiveness and efficiency in stroke rehabilitation.
abstract: BACKGROUND
  Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation.
  
  
  OBJECTIVE
  To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency.
  
  
  METHODS
  Using a retrospective cohort study design, we studied all stroke patients (n = 2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period.
  
  
  RESULTS
  Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β -4·7 (95% confidence interval -7·4 to -2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2-4·0) in effectiveness but a decrease of 0·04 (95% confidence interval -0·05 to -0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7-10·3) in effectiveness but a decrease of 0·82 (95% confidence interval -0·90 to -0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30-62 and length of stay was 37-41 days.
  
  
  CONCLUSIONS
  There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.
authors: Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. ephkohch@nus.edu.sg
authors: Gerald Choon-Huat
authors: GC
authors: Koh
authors: Cynthia
authors: C
authors: Chen
authors: Angela
authors: A
authors: Cheong
authors: Tai Bee
authors: TB
authors: Choo
authors: Choi Kwok
authors: CK
authors: Pui
authors: Fong Ngan
authors: FN
authors: Phoon
authors: Chan Kin
authors: CK
authors: Ming
authors: Tan Boon
authors: TB
authors: Yeow
authors: Robert
authors: R
authors: Petrella
authors: Amardeep
authors: A
authors: Thind
authors: David
authors: D
authors: Koh
authors: Chia Kee
authors: CK
authors: Seng
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D017028:Caregivers / Q000600:supply & distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore; D020521:Stroke / Q000208:ethnology; D000071939:Stroke Rehabilitation; D061665:Time-to-Treatment; D016896:Treatment Outcome