Effect of inpatient rehabilitation facility care on ninety day modified Rankin score in ischemic stroke patients

Maunica R Manchi; Aardhra M Venkatachalam; Folefac D Atem; Suzanne Stone; Amy A Mathews; Annie M Abraham; Audrie A Chavez; Babu G Welch; Nneka L Ifejika

doi:10.1016/j.jstrokecerebrovasdis.2023.107109

Effect of inpatient rehabilitation facility care on ninety day modified Rankin score in ischemic stroke patients

J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107109. doi: 10.1016/j.jstrokecerebrovasdis.2023.107109. Epub 2023 Apr 7.

Authors

Maunica R Manchi¹, Aardhra M Venkatachalam², Folefac D Atem³, Suzanne Stone⁴, Amy A Mathews¹, Annie M Abraham¹, Audrie A Chavez¹, Babu G Welch⁵, Nneka L Ifejika⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States.
² Ross University School of Medicine Miramar, FL, United States.
³ University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States.
⁴ University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁵ Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁶ Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States; Department of Neurology, University of Texas Southwestern Medical Center, DALLAS, TX, United States. Electronic address: Nneka.Ifejika@utsouthwestern.edu.

PMID: 37031503
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107109

Abstract

Objective: To determine Inpatient Rehabilitation Facility (IRF) treatment effect on modified Rankin Scale (mRS) scores at 90 days in acute ischemic stroke (AIS) patients.

Materials and methods: This prospective cross-sectional study included 738 AIS patients admitted 1/1/2018-12/31/2020 to a Comprehensive Stroke Center with a Stroke Rehabilitation program. We compared outcomes for patients who went directly home versus went to IRF at hospital discharge: (1) acute care length of stay (LOS), (2) National Institutes of Health Stroke Scale (NIHSS) score, (3) mRS score at hospital discharge and 90 days, (4) the proportion of mRS scores ≤ 2 from hospital discharge to 90 days.

Results: Among 738 patients, 499 went home, and 239 went to IRF. IRF patients were more likely to have increased acute LOS (10.7 vs 3.9 days; t-test, P<0.0001), increased mean NIHSS score (7.8 vs 4.8; t-test, P<0.0001) and higher median mRS score (3 vs 1, t-test, P<0.0001) compared to patients who went home. At 90 days, ischemic stroke patients who received IRF care were more likely to progress to a mRS ≤ 2 (18.7% increase) compared to patients discharged home from acute care (16.3% decrease). Home patients experienced a one-point decrease in mRS at 90 days compared to those who received IRF treatment (median mRS of 3 vs. 2, t-test, P<0.05).

Conclusions: In ischemic stroke patients, IRF treatment increased the likelihood of achieving mRS ≤ 2 at 90 days indicating the ability to live independently, and decreased the likelihood of mRS decrease, compared with patients discharged directly home after acute stroke care.

Keywords: Grotta bars; Inpatient rehabilitation facility; Ischemic stroke; Modified Rankin score; Stroke.

MeSH terms

Cross-Sectional Studies
Humans
Inpatients
Ischemic Stroke* / diagnosis
Ischemic Stroke* / therapy
Prospective Studies
Retrospective Studies
Stroke Rehabilitation*
Stroke* / diagnosis
Stroke* / therapy