title: Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis.
abstract: BACKGROUND
  Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination.
  
  
  METHODS
  This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke.
  
  
  RESULTS
  Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation.
  
  
  CONCLUSIONS
  Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or assisted living situation was an attainable goal. It is important to put substantial effort into the rehabilitation of patients in poor condition at admission.
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P,O,Box 9101, Nijmegen, 6500 HB, the Netherlands. B.Buijck@elg.umcn.nl
authors.forename: Bianca I
authors.initials: BI
authors.lastname: Buijck
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.forename: Monica
authors.initials: M
authors.lastname: Spruit-van Eijk
authors.forename: Hans
authors.initials: H
authors.lastname: Bor
authors.forename: Debby L
authors.initials: DL
authors.lastname: Gerritsen
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D036262:Empirical Research; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D010351:Patient Discharge; D020127:Recovery of Function; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000145:classification; D000071939:Stroke Rehabilitation; D014218:Triage