急性卒中的延迟住院康复与功能结局：澳大利亚一家地区医院的回顾性队列研究
Delayed inpatient rehabilitation and functional outcomes for acute stroke: a retrospective cohort study in an Australian regional hospital.
作者信息
He Fan, Blackberry Irene, Njovu Michael, Rutherford David, Mnatzaganian George
机构信息
John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Care Economy Research Institute, La Trobe University, Albury-Wodonga, Victoria, Australia.
John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Victoria, Australia; Care Economy Research Institute, La Trobe University, Albury-Wodonga, Victoria, Australia.
出版信息
J Rehabil Med. 2025 Aug 5;57:jrm42506. doi: 10.2340/jrm.v57.42506.
BACKGROUND
The impact of delayed inpatient rehabilitation on the functional outcomes of stroke patients has not been reported in regional Australia.
OBJECTIVE
This study examined the impact of delayed inpatient rehabilitation following acute stroke on functional outcomes (Relative Functional Gain and Functional Independence Measure efficiency) and length of stay in rehabilitation at a regional Australian hospital.
METHODS
Rehabilitation initiated > 24 h after a patient was deemed clinically ready was considered delayed. Associations between delayed inpatient rehabilitation and functional outcomes were investigated with mixed effects linear regression while length of stay was modelled using a negative binomial regression.
RESULTS
Of a total 487 patients, 301 (61.8%) experienced delayed inpatient rehabilitation, with a median delay of 2 days (interquartile range: 1-4 days). Multivariate regressions showed delayed inpatient rehabilitation was negatively associated with Relative Functional Gain (Beta: -0.07, 95% confidence interval [CI]: -0.11, -0.02, p = 0.009) and Functional Independence Measure efficiency (Beta: -0.18, 95% CI: -0.32, -0.04, p = 0.014), but positively associated with length of stay in rehabilitation wards (incidence rate ratio: 1.11, 95% CI: 1.02, 1.21, p = 0.021). Bed unavailability was the leading cause of delay.
CONCLUSION
Delayed inpatient rehabilitation is associated with poorer functional outcomes in stroke patients. Timely access to rehabilitation is crucial for optimising recovery.
背景
在澳大利亚地区，延迟住院康复对中风患者功能结局的影响尚未见报道。
目的
本研究探讨急性中风后延迟住院康复对澳大利亚一家地区医院中风患者功能结局（相对功能增益和功能独立性测量效率）及康复住院时间的影响。
方法
患者临床状况适宜后>24小时开始的康复被视为延迟康复。采用混合效应线性回归研究延迟住院康复与功能结局之间的关联，同时使用负二项回归对住院时间进行建模。
结果
在总共487例患者中，301例（61.8%）经历了延迟住院康复，中位延迟时间为2天（四分位间距：1 - 4天）。多变量回归显示，延迟住院康复与相对功能增益呈负相关（β：-0.07，95%置信区间[CI]：-0.11，-0.02，p = 0.009）以及与功能独立性测量效率呈负相关（β：-0.18，95% CI：-0.32，-0.04，p = 0.014），但与康复病房住院时间呈正相关（发病率比：1.11，95% CI：1.02，1.21，p = 0.021）。床位不可用是延迟的主要原因。
结论
延迟住院康复与中风患者较差的功能结局相关。及时获得康复治疗对优化恢复至关重要。
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