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Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis.

ABSTRACT: To examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people poststroke during the time they received outpatient therapies.Retrospective analyses of an observational cohort using hierarchical linear modeling.Outpatient rehabilitation.Persons poststroke (N=366).Usual outpatient physical and occupational therapy.Berg Balance Scale (BBS), Action Research Arm Test (ARAT), and walking speed were used to assess the 3 domains. Initial scores at the start of outpatient therapy (intercepts), rate of change during outpatient therapy (slopes), and covariance between slopes and intercepts were modeled as random effects. Additional variables modeled as fixed effects were duration (months of outpatient therapy), time (days poststroke), age (y), and inpatient status (if the patient went to an inpatient rehabilitation facility [IRF]).A patient with average age and time started at 37 points on the BBS with a change of 1.8 points per month, at 35 points on the ARAT with a change of 2 points per month, and with a walking speed of .59m/s with a change of .09m/s per month. When controlling for other variables, patients started with lower scores on the BBS and ARAT or had slower walking speeds at admission if they started outpatient therapy later than average or went to an IRF.Patients generally improved over the course of outpatient therapy, but there was considerable variability in individual trajectories. Average rates of change across all 3 domains were small.

SUBMITTER: Lohse K

PROVIDER: S-EPMC5003650 | biostudies-other | 2016 Sep

REPOSITORIES: biostudies-other

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Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis.

Lohse Keith K Bland Marghuretta D MD Lang Catherine E CE

Archives of physical medicine and rehabilitation 20160422 9

<h4>Objective</h4>To examine change and individual trajectories for balance, upper extremity motor capacity, and mobility in people poststroke during the time they received outpatient therapies.<h4>Design</h4>Retrospective analyses of an observational cohort using hierarchical linear modeling.<h4>Setting</h4>Outpatient rehabilitation.<h4>Participants</h4>Persons poststroke (N=366).<h4>Interventions</h4>Usual outpatient physical and occupational therapy.<h4>Main outcomes measures</h4>Berg Balance ...[more]

PMID: 27109329

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Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective.MethodsFirst, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service.ResultsThe analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033).ConclusionsMost COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients.

Dataset Information

Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis.

Publications

Quantifying Change During Outpatient Stroke Rehabilitation: A Retrospective Regression Analysis.

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