Background: Interpersonal relationships are understudied components of the stroke treatment paradigm, which become important when patients require long-term care. In this study, we analyzed sociodemographic factors that impact return to home after inpatient rehabilitation (IR).
Methods: Stroke patients were identified by ICD9/10 code from a prospective multicenter rehabilitation registry between Jan 2005 & July 2016 (n=6447). Patients were analyzed based upon "Home" vs "Not Home" or "Married" vs "Not Married" groups. Descriptive statistics were provided for all patients. Marital status was used as a proxy for caregiver support. We hypothesized that increased discharge functional independence measure (FIM), ambulation and no insurance predicted return to home. A “return home model” was developed using multivariable regression with a stepwise approach. Odds ratio & 95% CI were calculated.
Results: 5378 patients returned Home, 1069 did not return Home. Home patients tended to be younger, married, ambulatory and minorities, with a discharge FIM>75 (p<0.0001). Aphasia, dysphagia and UTI were significantly higher in the “Not Home” group (p<0.0001). Married patients had more stroke risk factors and impairments, indicating increased caregiver needs (Figure). In the model, being a minority and being a woman increased the odds of returning home. Advancing age, being widowed, divorced, separated or never married decreased the odds of returning home. We confirmed that ambulation, increasing discharge FIM and no insurance predicted return to home (Figure).
Conclusions: Being married, a woman or a minority increases the odds of returning home after inpatient rehabilitation. Caregiver training and social support for unmarried and male patients are important areas of improvement. Strategies to ensure the successful transition of stroke rehabilitation patients to home are needed, including prospective studies of non-spousal caregiver support.