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Bijl T1, Mudzi W2, Comley-White N1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2University of the Free State, Postgraduate School, Bloemfontein, South Africa
Background: Stroke is the main cause of disability in South Africa. Patients who have a stroke require effective rehabilitation to achieve optimal function. Patient progress can be monitored with standardised outcome measures such as the Functional Independence Measure (FIM). This data along with other demographic and clinical information may be useful in making predictions about patients' functional outcomes and length of hospital stay (LOS). As LOS is an important indicator of the cost of care for patients post-stroke, this information may be useful to all stakeholders involved in the care and rehabilitation process.
Purpose: The aim of this study was to determine the factors that predict hospital LOS in patients admitted to a private, sub-acute rehabilitation setting in Gauteng, South Africa, post-stroke.
Methods: A retrospective file review was done for 247 patients post-stroke who were admitted to a private, sub-acute rehabilitation facility in Gauteng, South Africa, between 1 January 2015- 31 January 2017. Patient functional ability was measured using the FIM. Demographic and clinical details of the patients were also recorded. Descriptive statistics were used to summarise the data. Median and range values were used to describe the sample, their functional outcomes and their LOS. To determine if there were differences in patient outcomes (FIM scores and LOS) one-way ANOVA was done. Multiple regression analysis was done to determine the predictive value of clinical, demographic and functional variables on LOS.
Results: The median admission and discharge FIM scores were 43 points and 75 points respectively, and the median LOS was 43 days. Only admission FIM score had an influence on both discharge FIM score and FIM change scores. With the stepwise multiple regression model, the following patient characteristics were found to be predictors of LOS: the presence of a premorbid psychiatric condition, impaired speech on admission, requiring additional oxygen support, the development of pneumonia and the admission FIM motor score. The overall variance predicted by the model was 26.3%. Admission FIM motor score was the strongest individual predictor of LOS in this study (41%).
Conclusion(s): Admission FIM score has an influence on patient outcomes and is important in the prediction of LOS for patients post-stroke in a sub-acute rehabilitation facility in South Africa. Low functioning patients post stroke stay longer in hospital and may require more resources to get them to functional levels.
Implications: FIM scores should be routinely used on patients post-stroke to enable better planning in terms of hospital length of stay and the resources needed by the patient. Future studies should consider using regression analyses to determine predictors of functional outcome as well as LOS. From the study, it is recommended that rehabilitation facilities should implement the use of more standardised outcome measures to improve the quality of data collected at these facilities.
Keywords: Length of stay, functional outcome, stroke
Funding acknowledgements: This study was not funded.
Purpose: The aim of this study was to determine the factors that predict hospital LOS in patients admitted to a private, sub-acute rehabilitation setting in Gauteng, South Africa, post-stroke.
Methods: A retrospective file review was done for 247 patients post-stroke who were admitted to a private, sub-acute rehabilitation facility in Gauteng, South Africa, between 1 January 2015- 31 January 2017. Patient functional ability was measured using the FIM. Demographic and clinical details of the patients were also recorded. Descriptive statistics were used to summarise the data. Median and range values were used to describe the sample, their functional outcomes and their LOS. To determine if there were differences in patient outcomes (FIM scores and LOS) one-way ANOVA was done. Multiple regression analysis was done to determine the predictive value of clinical, demographic and functional variables on LOS.
Results: The median admission and discharge FIM scores were 43 points and 75 points respectively, and the median LOS was 43 days. Only admission FIM score had an influence on both discharge FIM score and FIM change scores. With the stepwise multiple regression model, the following patient characteristics were found to be predictors of LOS: the presence of a premorbid psychiatric condition, impaired speech on admission, requiring additional oxygen support, the development of pneumonia and the admission FIM motor score. The overall variance predicted by the model was 26.3%. Admission FIM motor score was the strongest individual predictor of LOS in this study (41%).
Conclusion(s): Admission FIM score has an influence on patient outcomes and is important in the prediction of LOS for patients post-stroke in a sub-acute rehabilitation facility in South Africa. Low functioning patients post stroke stay longer in hospital and may require more resources to get them to functional levels.
Implications: FIM scores should be routinely used on patients post-stroke to enable better planning in terms of hospital length of stay and the resources needed by the patient. Future studies should consider using regression analyses to determine predictors of functional outcome as well as LOS. From the study, it is recommended that rehabilitation facilities should implement the use of more standardised outcome measures to improve the quality of data collected at these facilities.
Keywords: Length of stay, functional outcome, stroke
Funding acknowledgements: This study was not funded.
Topic: Neurology: stroke; Disability & rehabilitation; Outcome measurement
Ethics approval required: Yes
Institution: University of the Witwatersrand
Ethics committee: Human Research Ethics Committee (medical)
Ethics number: M160936
All authors, affiliations and abstracts have been published as submitted.
