From the Kaiser Foundation Rehabilitation Center, Vallejo, California (HW, MC); Uniform Data System for Medical Rehabilitation, Amherst, New York (MD, JM, PN); and State University of New York at Cortland (MD).
Am J Phys Med Rehabil. 2015 Feb;94(2):85-96; quiz 97-100. doi: 10.1097/PHM.0000000000000226.
The aim of this study was to examine the associations of onset days, time from stroke onset to inpatient rehabilitation facility (IRF) admission, and patient outcomes (FIM gain, discharge destination, and IRF length of stay), using nationally representative data.
A secondary data analysis was conducted on a random sample of stroke patients discharged from IRFs in the United States between 2009 and 2011, including mildly (n = 649), moderately (n = 2185), and severely (n = 2390) impaired patients.
The study sample had a median of onset days of 5.5, with an interquartile range of 4-9. With the use of 15-365 days as reference, the severely impaired patients had a higher cognition gain (P < 0.01) and were more likely to be discharged to the community (odds ratio, 1.45; 95% confidence interval, 1.12-1.87) when admitted within 7 days, a greater motor gain when admitted within 14 days (P < 0.01), and a lower risk for acute hospital transfer when admitted 3-7 days (odds ratio, 0.62; 95% confidence interval, 0.43-0.90). The moderately impaired patients had a greater motor gain when admitted within 7 days (P < 0.01). Early IRF admission was also associated with a shorter length of stay.
Earlier IRF admission was beneficial among severely and moderately impaired patients. IRF admission within 7 days is recommended for stroke patients who achieved medical stability.
本研究旨在使用全国代表性数据，考察发病日、从发病到入住康复机构（IRF）的时间以及患者结局（FIM 增益、出院去向和 IRF 住院时间）之间的关联。
对 2009 年至 2011 年期间从美国 IRF 出院的轻度（n=649）、中度（n=2185）和重度（n=2390）受损患者的随机样本进行二次数据分析。
研究样本的发病日中位数为 5.5 天，四分位距为 4-9 天。以 15-365 天为参照，严重受损患者认知功能增益更高（P<0.01），且在发病后 7 天内入院更有可能出院至社区（优势比，1.45；95%置信区间，1.12-1.87），14 天内入院时运动功能增益更大（P<0.01），3-7 天内入院时急性医院转院风险较低（优势比，0.62；95%置信区间，0.43-0.90）。中度受损患者在发病后 7 天内入院时运动功能增益更大（P<0.01）。早期 IRF 入院也与住院时间缩短有关。
严重和中度受损患者的早期 IRF 入院是有益的。对于已达到医疗稳定的中风患者，建议在发病后 7 天内入住 IRF。
