Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. Salter K, Jutai J, Hartley M, Foley N, Bhogal S, Bayona N, Teasell R. From the Department of Physical Medicine and Rehabilitation, Parkwood Hospital, St Joseph's Health Centre J Rehabil Med Mar;38(2):113-7.

Objective: Delayed admission to rehabilitation may result in poorer outcomes by reducing exposure to therapeutic interventions at a time when the brain is primed for neurological recovery. The present study examined the effects of early vs delayed admission on functional outcome and length of stay in patients admitted to a rehabilitation unit for first-ever unilateral stroke.

Design: Retrospective chart review.

Methods: Differences in length of rehabilitation stay and functional outcome variables among 435 patients, grouped by interval from stroke event to rehabilitation admission (=30 days vs days and 5 additional subgroups) were examined using a multivariate technique.

Results: Admission and discharge FIM scores, FIM change and FIM efficiency were significantly higher among early admission patients (p<0.01), while length of stay was significantly longer among delayed admission patients (p<0.01). A significant association was identified between age and admission (p<0.01) and discharge FIM (p<0.01) scores as well as FIM change scores (p=0.017).

Subgroup analyses revealed significant differences in FIM cores, FIM change and length of stay between groups of patients admitted 0-15 and days (p<0.01) and between patients admitted days and days post-stroke (p<0.01). No significant differences were noted between patients admitted from and or and days.

Conclusion: Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days.

Timing of Initiation of Rehabilitation After Stroke Sarah A. Maulden, MD, MS, Julie Gassaway, MS, RN, Susan D. Horn, PhD, Randall J. Smout, MS, Gerben DeJong, PhD Arch Phys Med Rehabil Vol 86, Suppl 2, December 2005

Objective: To study associations between days from stroke symptom onset to rehabilitation admission and rehabilitation outcomes, controlling for a variety of confounding variables.

Design: Observational cohort study of 200 consecutive poststroke rehabilitation patients in each of 6 inpatient rehabilitation facilities. Setting: Six U.S. inpatient rehabilitation hospitals. Participants: Patients (N969) with moderate or severe strokes who had days from stroke symptom onset to rehabilitation admission recorded in their medical records.

case-mix groups (CMGs) Severe stroke : CMGs 108–114, Moderate stroke: CMGs 104–107,

Motor score The motor score is the sum of the scores for 12 of the 13 FIM motor items: The score for transfers tube, shower is not included Eating + Grooming + Bathing + Dressing upper + Dressing lower + Toileting + Bladder management + Bowel management + Transfers: bed, chair, WC + Transfers: toilet + walk/WC + stairs Items scored 0 will be recorded to 1 in the grouper software Range of motor score: 12 to 84 Cognitive score the cognitive score is the sum of the scores for the 5 FIM cognitive items: Comprehension + Expression + Social interaction + Problem solving + Memory Range of cognitive score: 5 to 35

CMGs for stroke CMGMotor scoreCognitive scoreAge to 8423 to to 6823 to to 845 to to to 52

CMGs for stroke CMGMotor scoreCognitive scoreAge to to to 38 ≧ to 38 ≦ to 33 ≧ 89

CMGs for stroke CMGMotor scoreCognitive scoreAge to to to 33 ≦ to 26 ≦ 81

Main Outcome Measures: Discharge total FIM, discharge motor FIM, discharge activities of daily living (ADL) FIM, and discharge mobility FIM scores, as well as rehabilitation length of stay (LOS).

Conclusions: Fewer days from stroke symptom onset to rehabilitation admission is associated with better functional outcomes at discharge and shorter LOS.