Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States.
Ross University School of Medicine Miramar, FL, United States.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107109. doi: 10.1016/j.jstrokecerebrovasdis.2023.107109. Epub 2023 Apr 7.
To determine Inpatient Rehabilitation Facility (IRF) treatment effect on modified Rankin Scale (mRS) scores at 90 days in acute ischemic stroke (AIS) patients.
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.
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).
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.
确定住院康复机构（IRF）对急性缺血性脑卒中（AIS）患者 90 天改良 Rankin 量表（mRS）评分的治疗效果。
这项前瞻性的横断面研究纳入了 2018 年 1 月 1 日至 2020 年 12 月 31 日期间因 AIS 入住综合卒中中心并接受卒中康复项目的 738 名患者。我们比较了直接出院回家的患者与出院后入住 IRF 的患者的结局：（1）急性护理住院时间（LOS），（2）国立卫生研究院卒中量表（NIHSS）评分，（3）出院时和 90 天时的 mRS 评分，（4）从出院到 90 天 mRS 评分≤2 的比例。
在 738 名患者中，499 名出院回家，239 名入住 IRF。与出院回家的患者相比，IRF 患者的急性 LOS （10.7 天比 3.9 天；t 检验，P<0.0001）、平均 NIHSS 评分（7.8 分比 4.8 分；t 检验，P<0.0001）和中位数 mRS 评分（3 分比 1 分；t 检验，P<0.0001）更高。在 90 天时，接受 IRF 治疗的缺血性卒中患者更有可能进展为 mRS≤2（增加 18.7%），而直接从急性护理出院的患者则减少（减少 16.3%）。与接受 IRF 治疗的患者相比，回家的患者在 90 天时 mRS 评分下降了 1 分（中位数 mRS 为 3 分比 2 分，t 检验，P<0.05）。
在缺血性卒中患者中，与直接出院回家的患者相比，IRF 治疗可提高 90 天时达到 mRS≤2 的可能性，表明患者能够独立生活，同时降低 mRS 下降的可能性。
