Timing of rehabilitation after stroke: a multivariate analysis

Update item information
Publication Type thesis
School or College School of Medicine
Department Biomedical Informatics
Author Maulden, Sarah A.
Title Timing of rehabilitation after stroke: a multivariate analysis
Date 2004-08
Description Does timing of rehabilitation after stroke affect outcomes? The association between early rehabilitation and better functional outcomes has been found by some to disappear when controlling for function on admission to rehabilitation. Very early rehabilitation might be harmful via oxidative/metabolic stress to injured brain cells. Since timing of rehabilitation is potentially modifiable, it is important to discern how it affects outcomes for certain types of patients. In this exploratory data analysis, Clinical Practice Improvement methodology was applied using the Post-Stroke Rehabilitation Outcomes Project database. Data on 1168 stroke patients were collected using chart abstraction; scannable documentation forms captured details of rehabilitation interventions. The Comprehensive Severity Index was used to measure severity in the acute hospital and rehabilitation settings. Statistical models were developed based on clinical experience and review of prior literature and were designed to control for potential interactions and confounders. Ordinary least squares and logistic regression analyses were performed using SAS. After excluding patients treated outside the U.S. and patients who died, 1033 patients were analyzed. For patients entering rehabilitation with severe functional impairment, earlier acute hospital therapy was significantly associated (p<0.0001 to p=0.0316) with better outcomes in multiple functional domains (measured by the Functional Independence Measure or FIM). For patients with moderate impairment,earlier therapy was associated with better mobility. For all but the most and least impaired, more acute hospital therapy was associated with better functional outcomes in several domains. Discharge to a skilled nursing facility prior to rehabilitation admission was associated with lower functional scores and lower likelihood of improvement. Overall, these findings support the hypothesis that earlier rehabilitation is associated with better outcomes, after controlling for severity and admission function. Patients with either minimal or maximal impairment were less likely to show benefit. Lack of initial stroke severity scores and absence of pertinent acute hospital data were important limitations. Assessing patients at discharge, rather than at predetermined endpoints, introduced additional bias related to discharge patterns. Nonetheless, this study revealed new insights into the effects of delaying poststroke rehabilitation for particular types of patients.
Type Text
Publisher University of Utah
Subject Interventions; Stroke
Subject MESH Cerebrovascular Disorders; Rehabilitation; Patients
Dissertation Institution University of Utah
Dissertation Name MS
Language eng
Relation is Version of Digital reproduction of "Timing of rehabilitation after stroke: a multivariate analysis." Spencer S. Eccles Health Sciences Library. Print version of "Timing of rehabilitation after stroke: a multivariate analysis." available at J. Willard Marriott Library Special Collection. RC39.5 2004 .M38.
Rights Management © Sarah A. Maulden.
Format Medium application/pdf
Format Extent 713,293 bytes
Identifier undthes,5240
Source Original: University of Utah Spencer S. Eccles Health Sciences Library (no longer available).
Master File Extent 713,345 bytes
ARK ark:/87278/s6183875
Setname ir_etd
Date Created 2012-04-24
Date Modified 2012-04-24
ID 190598
Reference URL https://collections.lib.utah.edu/ark:/87278/s6183875