Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA.
J Neurol Sci. 2022 Nov 15;442:120383. doi: 10.1016/j.jns.2022.120383. Epub 2022 Aug 18.
Stroke survivors with residual disabling deficits who are medically stable may be recommended for acute rehabilitation or outpatient therapy, depending partly on the severity of their deficits. Here we sought to determine if the location at which patients needing rehabilitation post-stroke has shifted from inpatient to an outpatient setting.
For analysis, we used our Institutional Review Board-approved Get With The Guidelines®-Stroke Database to study stroke survivors discharged to receive either inpatient or outpatient rehabilitation services between 2014 and 2019. Logistic regression analysis was used to identify clinical factors associated with discharge type. Cochran-Armitage trend analysis was used to assess differences in rehabilitation services used over time.
A total of 3293 patients were included. Trend analysis demonstrated a significant increase over time in the proportion of patients needing rehabilitation being discharged home with rehabilitation services (P < 0.0001). In addition, older age was associated with discharge to inpatient rehabilitation (OR = 1.018, 95%CI, 1.011-1.026), as was a higher National Institutes of Health Stroke Scale score (OR = 1.149, 95%CI, 1.130-1.168).
We found that home discharges increased, highlighting outpatient rehabilitation as an expanding healthcare resource for reducing stroke-associated disability in adults.
对于那些有残余残疾且病情稳定的中风幸存者，可能会根据其残疾程度的严重程度，建议他们接受急性康复或门诊治疗。在这里，我们试图确定中风后需要康复的患者的治疗地点是否已经从住院治疗转移到门诊治疗。
为了进行分析，我们使用了经机构审查委员会批准的 Get With The Guidelines®-Stroke 数据库，研究了 2014 年至 2019 年期间出院后接受住院或门诊康复服务的中风幸存者。使用逻辑回归分析来确定与出院类型相关的临床因素。使用 Cochran-Armitage 趋势分析来评估随时间推移康复服务使用的差异。
共纳入 3293 名患者。趋势分析表明，需要康复的患者中，在家中接受康复服务的比例显著增加（P < 0.0001）。此外，年龄越大与接受住院康复治疗的相关性越强（OR = 1.018，95%CI，1.011-1.026），NIHSS 评分越高（OR = 1.149，95%CI，1.130-1.168）。
我们发现出院回家的患者比例增加，这突出表明门诊康复作为减少成人中风相关残疾的一种扩大的医疗资源。
