Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage

Abstract

Objective: Assess the association of time to initiation of acute rehabilitation therapy with disability after intracerebral hemorrhage (ICH) and identify predictors of time to initiation of rehabilitation therapy.

Design: Retrospective data analysis of prospectively collected data from an ongoing observational cohort study.

Setting: Large comprehensive stroke center in a metropolitan area.

Participants: Adults with ICH consecutively admitted (n=203).

Interventions: Not applicable.

Main outcome measures: Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as the number of days between hospital admission and the first consult by any rehabilitation therapy specialist (eg, physical therapy, occupational therapy, speech therapy).

Results: The median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 (range=2-7). Multivariable logistic regression models indicated that each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome at 30 days (adjusted odds ratio [OR]=1.151; 95% confidence interval [CI]=1.044-1.268; P=.005) and at 90 days (adjusted OR=1.107; 95% CI=1.003-1.222; P=.044) for patients with ICH. A multivariable linear regression model used to identify the predictors of time to initiation of rehabilitation therapy identified heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism, and longer length of stay in the intensive care unit as independent predictors of later initiation of acute rehabilitation therapy.

Conclusions: Longer time to initiation of acute rehabilitation therapy after ICH may have persistent effects on poststroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.

Keywords: Cerebral hemorrhage; Health services research; Rehabilitation.

Figure 1.

Distribution of 30-day modified Rankin Scale (mRS) < 4 (i.e., good outcome) and mRS ≥4 (i.e, poor outcome) by time to initiation of acute rehabilitation therapy. (n=186)