Abstract
A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients' functioning. Objective: The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Design: This was a single-center longitudinal observational study. Methods: Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both. Results: Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19-0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28-0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23-0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6-15: OR = 1.43 [95% CI = 1.01-2.33]) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91-13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non-intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations. Limitations: Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions. Conclusions: Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1431-1442 |
| Number of pages | 12 |
| Journal | Physical therapy |
| Volume | 99 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 25 2019 |
Funding
This work was funded in part by the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR000150 and UL1TR001422). Funding also was provided by a National Research Service Award postdoctoral fellowship at the Center for Education in Health Sciences, under an institutional award from the Agency for Healthcare Research and Quality (T-32 HS 000078) (principal investigator: Jane L. Holl, MD). This research also was supported by a Foundation for Physical Therapy Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training grant. The funders played no role in the design, conduct, or reporting of this study. This work was funded in part by the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR000150 and UL1TR001422). Funding also was provided by a National Research Service Award postdoctoral fellowship at the Center for Education in Health Sciences, under an institutional award from the Agency for Health care Research and Quality (T-32 HS 000078) (principal investigator: Jane L. Holl, MD). This research also was supported by a Foundation for Physical Therapy Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training grant. The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest. C.E. Capo-Lugo is currently funded by a National Institute on Disability, Independent Living, and Rehabilitation Research grant (90SF0010) and a Foundation for Physical Therapy Research Center of Excellence in Physical Therapy Health Services and Health Policy Research and Training grant. S. Prabhakaran receives support from the National Institutes of Health and Patient Centered Outcomes Research Institute. A. Naidech receives support from the Agency for Health care Research and Quality (HS023437).
Keywords
- Acute Stroke
- Health Services Research
- Logistic Regression
- Neurological Rehabilitation
- Registry
ASJC Scopus subject areas
- General Medicine
