Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.
BACKGROUND
Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units.


METHODS
We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient's classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes).


RESULTS
Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54-8.63 and OR = 3.0, 95%CI = 1.52-5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81-10.75 and OR = 3.45, 95%CI = 1.31-9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65-17.03 and OR = 3.87, 95%CI = 1.69-8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23-0.75) and HCC (OR = 0.37, 95%CI = 0.19-0.73), for LOS lower Vs higher tertiles.


CONCLUSIONS
Our data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.
Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain.|Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain.
Laura M
http://orcid.org/0000-0003-3152-9882
LM
Pérez
Convalescence and Rehabilitation Unit, Hospital Parc Sanitari Pere Virgili, Barcelona, Spain.|Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain.
Marco
M
Inzitari
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Terence J
TJ
Quinn
Neurology Department, Neurovascular Research Laboratory (VHIR), Vall D´Hebrón Hospital, Barcelona, Spain.
Joan
J
Montaner
Department of Computer Science, Universitat Politécnica de Catalunya, Barcelona, Spain.
Ricard
R
Gavaldà
Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Spain.
Esther
E
Duarte
Fundació Salut i Envillement, Universitàt Autónoma de Barcelona, Barcelona, Spain.
Laura
L
Coll-Planas
Catalan Healthcare Service, Government of Catalonia, Barcelona, Spain.
Mercè
M
Cerdà
Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain.|Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Spain.
Sebastià
S
Santaeugenia
Rehabilitation Department, Corporación Fisiogestión, Barcelona, Spain.
Conxita
C
Closa
Pla Director Malaltia Vascular Cerebral, Department of Health, Government of Catalonia, Barcelona, Spain.
Miquel
M
Gallofré
D000203:Activities of Daily Living; D000368:Aged; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000706:statistics & numerical data*