Kaiser Foundation Rehabilitation Center, 975 Sereno Dr, Vallejo, CA 94589, USA.
PM R. 2011 Apr;3(4):296-304; quiz 304. doi: 10.1016/j.pmrj.2010.12.018.
To study the association of time to inpatient rehabilitation hospital (IRH) admission and functional outcomes of patients who have had a stroke.
A retrospective cohort study.
A regional IRH.
Moderately (n = 614) and severely (n = 1294) impaired patients who had a stroke who were admitted to the facility between 2002 and 2006.
Not applicable.
Change in total, motor, and cognitive Functional Independence Measure (FIM) scores between IRH admission and discharge.
After controlling for patient demographics and initial medical conditions and functional status, shorter periods from stroke onset to IRH admission were significantly associated with greater functional gains for these patients during IRH hospitalization. Moderately impaired patients achieved a greater total FIM gain when admitted to an IRH within 21 days of stroke. Severely impaired patients showed a gradient relationship between time to IRH admission and total FIM gain, with significantly different functional gain if admitted to an IRH within 30 and 60 days after stroke diagnosis. Results of multiple regression analysis also showed that age, race/ethnicity, side of stroke, history of a previous stroke, functional measures at IRH admission, IRH length of stay, and selected medications were associated with total, motor, and cognitive FIM score changes. In addition, certain factors such as older age, diagnosis of a hemorrhagic stroke or a previous history of stroke, and initial functional status were associated with longer periods between diagnosis and admission to an IRH after the stroke occurred.
Our findings are consistent with the hypothesis that earlier transfer to an IRH may lead to better functional improvement after stroke. However, certain factors such as age, race/ethnicity, initial medical conditions and functional status, and length of stay at an IRH contributed to functional gain. Factors affecting the time to IRH admission also were addressed.
研究卒中患者住院康复时间与功能结局的相关性。
回顾性队列研究。
一家区域性住院康复医院。
2002 年至 2006 年间入住该机构的中度（n=614）和重度（n=1294）功能障碍卒中患者。
无。
从住院康复医院入院到出院期间，总、运动和认知功能独立性测量（FIM）评分的变化。
在控制了患者人口统计学特征、初始医疗状况和功能状态后，卒中发病到住院康复医院入院的时间越短，这些患者在住院康复期间的功能增益越大。中度受损患者在卒中后 21 天内入住住院康复医院时，总 FIM 增益更大。严重受损患者的住院康复医院入院时间与总 FIM 增益呈梯度关系，如果在卒中诊断后 30 天和 60 天内入住住院康复医院，功能增益有显著差异。多元回归分析结果还显示，年龄、种族/民族、卒中侧、既往卒中史、住院康复医院入院时的功能测量、住院康复医院住院时间以及选定药物与总、运动和认知 FIM 评分变化相关。此外，某些因素，如年龄较大、诊断为出血性卒中或既往卒中史，以及初始功能状态，与卒中发生后至入住住院康复医院的时间间隔较长有关。
我们的研究结果与以下假设一致，即更早地转至住院康复医院可能会导致卒中后更好的功能改善。然而，某些因素，如年龄、种族/民族、初始医疗状况和功能状态以及住院康复医院的住院时间，也会影响功能增益。还探讨了影响住院康复医院入院时间的因素。
