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Title: Out of sight, out of mind: long-term outcomes for people discharged home, to inpatient rehabilitation and to residential aged care after stroke.
Austin Authors: Lynch, Elizabeth A;Labberton, Angela S;Kim, Joosup;Kilkenny, Monique F;Andrew, Nadine E;Lannin, Natasha A;Grimley, Rohan;Faux, Steven G;Cadilhac, Dominique A
Affiliation: Adelaide Nursing School, University of Adelaide, Adelaide, Australia..
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway..
Stroke and Ageing Research Centre, Department of Medicine, Monash University, Clayton, Victoria, Australia..
NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia..
Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Victoria, Australia..
Department of Neuroscience, Monash University, Clayton, Victoria, Australia..
Department of Medicine, Griffith University, Nathan, Australia..
St Vincent's Hospital, Sydney, Australia..
Institute of Medicine, University of Oslo, Oslo, Norway..
The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia..
Occupational Therapy Department, Alfred Health, Prahran, Australia..
University of New South Wales, Sydney, Australia..
Issue Date: Jun-2022
Date: 2020
Publication information: Disability and rehabilitation 2022; 44(12): 2608-2614
Abstract: The aim of this study was to describe differences in long-term outcomes for patients discharged to inpatient rehabilitation facilities (IRFs) following stroke compared to patients discharged directly home or to residential aged care facilities (RACFs). Cohort study. Data from the Australian Stroke Clinical Registry were linked to hospital admissions records and the national death index. Main outcomes: death and hospital readmissions up to 12 months post-admission, Health-related Quality of Life (HRQoL) 90-180 days post-admission. Of 8,555 included patients (median age 75, 55% male, 83% ischemic stroke), 4,405 (51.5%) were discharged home, 3,442 (40.2%) to IRFs, and 708 (8.3%) to RACFs.No between-group differences were observed in hazard of death between patients discharged to IRFs versus home. Fewer patients discharged to IRFs were readmitted to hospital within 90, 180 or 365-days compared to patients discharged home (adjusted subhazard ratio [aSHR]:90-days 0.54, 95%CI 0.49, 0.61; aSHR:180-days 0.74, 95%CI 0.67, 0.82; aSHR:365-days 0.85, 95%CI 0.78, 0.93). Fewer patients discharged to IRFs reported problems with mobility compared to those discharged home (adjusted OR 0.54, 95%CI 0.47, 0.63), or to RACFs (aOR 0.35, 95%CI 0.25, 0.48). Overall HRQoL between 90-180 days was worse for people discharged to IRFs versus those discharged home and better than those discharged to RACFs. Several long-term outcomes differed significantly for patients discharged to different settings after stroke. Patients discharged to IRFs reported some better outcomes than people discharge directly home despite having markers of more severe stroke.Implications for rehabilitationPeople with mild strokes are usually discharged directly home, people with moderate severity strokes to inpatient rehabilitation, and people with very severe strokes are usually discharged to residential aged care facilities.People discharged to inpatient rehabilitation reported fewer problems with mobility and had a reduced risk of hospital readmission in the first year post-stroke compared to people discharged directly home after stroke.The median self-reported health-related quality of life for people discharged to residential aged care equated to 'worst health state imaginable'.
DOI: 10.1080/09638288.2020.1852616
ORCID: 0000-0001-8756-1051
Journal: Disability and rehabilitation
PubMed URL: 33307842
PubMed URL:
Type: Journal Article
Subjects: Stroke
information storage and retrieval
patient readmission
quality of life
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