García-Rudolph Alejandro, Cegarra Blanca, Opisso Eloy, Tormos Josep María, Bernabeu Montserrat, Saurí Joan
Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès).
Medicine (Baltimore). 2020 Oct 23;99(43):e22423. doi: 10.1097/MD.0000000000022423.
Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission.A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated (P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models.No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) (P < .001) and hemiparesis (P = .0108) (adjusted R = 0.24), 2) cognitive FIM (P = .002) and severity (P = .001) (adjusted R = 0.22), and 3) home accessibility (P = .043) and hemiparesis (P = 0.032) (adjusted R = 0.19).Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset.Socioeconomic situation was found moderately correlated with total FIM (r = -0.32, P < .0001).When stratifying the patients' socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group (P < .001); also significant differences were found between mild and severe groups (P < .001).A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients.Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.
已知重症中风患者的康复住院时间（LOS）较长，但除病情严重程度外，其他因素可能也有影响。我们旨在确定大多数重症患者群体中的住院时间预测因素，并分析社会经济状况对入院时功能的影响。
我们进行了一项回顾性观察队列研究，纳入了2007年至2019年间在一家康复中心住院的172名患者。使用双变量相关性检验了30个潜在预测变量与住院时间的关联。将显著相关（P<0.002，Bonferroni校正）的变量纳入9个不同的多元线性回归模型。
未纳入轻度患者，63.37%为重度患者，36.63%为中度患者。最显著的住院时间决定因素为：1）总功能独立性测量（FIM）（P<0.001）和偏瘫（P=0.0108）（调整后R=0.24），2）认知FIM（P=0.002）和病情严重程度（P=0.001）（调整后R=0.22），以及3）家庭无障碍性（P=0.043）和偏瘫（P=0.032）（调整后R=0.19）。
在整个中风严重程度范围内，文献中已知的住院时间预测因素（如抑郁、共济失调）在我们的数据集中未发现显著意义。
发现社会经济状况与总FIM中度相关（r=-0.32，P<0.0001）。
将患者的社会经济状况分为轻度、中度和重度社会风险时，他们入院时各自的总FIM中位数分别为61.5、50和41，轻度和中度组之间存在显著差异（P<0.001）；轻度和重度组之间也存在显著差异（P<0.001）。
文献中确定的在整个中风人群中作为住院时间显著预测因素的一些变量在我们的数据集中也具有显著性（美国国立卫生研究院卒中量表、FIM、家庭无障碍性），但解释的住院时间方差不到25%。分析的30个已知预测因素中的大多数不具有显著性（如抑郁、年龄、复发性中风、共济失调、定向、言语交流等），这表明本研究未包括的功能、社会经济、医疗和人口统计学之外的因素（如康复治疗强度）对重症患者的住院时间有重要影响。
轻度社会风险患者入院时的总FIM显著高于中度和重度社会风险患者。社会经济状况与入院时功能的关系在文献中很少被研究；我们的结果表明需要对此加以考虑。
