Outcome Measure Scores Predict Discharge Destination in Patients With Acute and Subacute Stroke: A Systematic Review and Series of Meta-analyses

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Abstract

Background and Purpose:

To identify the association between outcome measure score and discharge destination in adults following acute or subacute stroke in the United States.

Methods:

A systematic literature search was performed in 3 databases using the PRISMA guidelines. Cohort studies were selected that included patients with acute or subacute stroke, which explored the relationship between scores on outcome measures and discharge destination. Four meta-analyses were performed.

Results:

Nine articles met the inclusion criteria for systematic review and 5 for the series of meta-analyses. For every 1-point increase on the Functional Independence Measure (FIM), a patient is approximately 1.08 times more likely to be discharged home than to institutionalized care (odds ratio [OR] = 1.079; 95% confidence interval [CI], 1.056- 1.102). Patients with stroke who performed above-average (FIM ≥80; NIH Stroke Scale [NIHSS] score ≤5; etc) are 12 times (OR = 12.08; 95% CI, 3.550-41.07) more likely to discharge home. Patients who perform poorly (FIM ≤39; NIHSS score ≥14), experience discharge to institutionalized care 3.4 times (OR = 3.385; 95% CI, 2.591-4.422) more likely than home, with skilled nursing facility admission more likely than inpatient rehabilitation facility. Patients who perform average (FIM = 40-79; NIHSS score = 6-13) are 1.9 times (OR = 1.879; 95% CI, 1.227-2.877) more likely to be discharged to institutionalized care.

Discussion and Conclusion:

Outcome measure scores are strong predictors of discharge destination among patients with stroke and provide an objective means of early discharge planning. Discharge decisions should be made with consideration for patient-specific biopsychosocial factors that may supersede isolated results of the outcome measures, and further research needs to assess the success of the location that a patient is referred at discharge.

Discussion and Conclusion:

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A194).

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