title: Stroke patients after neurological inpatient rehabilitation: a prospective study to determine whether functional status or health-related quality of life predict living at home 2.5 years after discharge.
abstract: We carried out a prospective study to determine whether stroke patients' functional status or health-related quality of life would predict whether they lived at home 2.5 years after discharge from neurological inpatient rehabilitation. We carried out a single-center prospective cohort study. The outcome 'home care' versus 'death' or 'institutionalization' (nursing home admission) was evaluated 30 months after discharge. A total of 204 stroke survivors with remaining moderate to severe functional deficits at admission to neurological inpatient rehabilitation were included. Clinical data were obtained at admission to and/or discharge from inpatient rehabilitation. Functional status was determined using the Barthel Index; health-related quality of life was assessed using the SF-36 and EQ-5D. The outcome was assessed by telephone interview. Predictors of living at home were calculated using binary logistic regression analysis. In total, 30 months after discharge, 75% of the stroke survivors were still living at home. Multivariate analysis showed that patients continued to live at home significantly more frequently when they had fewer mortality-relevant comorbidities (P=0.001), a higher BMI (P=0.040), a higher increase in functional independence during inpatient rehabilitation (P=0.017), and above all, a better health-related quality of life, measured using the EQ-5D (P<0.001), at discharge. Stroke survivors' health-related quality of life measured with the EQ-5D and the change in functional status during multimodal neurological rehabilitation appear to be the strongest clinically relevant long-term predictors of staying at home.
authors.affiliation: aDepartment of Psychiatry and Psychotherapy, Center for Health Services Research in Medicine, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen-Nuernberg bDepartment of Neurology and Neuropsychology, Clinic for Specialised In- and Outpatient Rehabilitation Medicine, Herzogenaurach, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Graessel
authors.forename: Ralf
authors.initials: R
authors.lastname: Schmidt
authors.forename: Wilfried
authors.initials: W
authors.lastname: Schupp
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006760:Hospitalization; D006801:Humans; D057187:Independent Living; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011446:Prospective Studies; D011788:Quality of Life; D000071939:Stroke Rehabilitation