Article

The objective of this study was to identify the variables associated with
discharge to inpatient rehabilitation following acute severe stroke and to
determine whether hospital unit contributed to access. Five acute hospitals in
Victoria, Australia participated in this study. Patients were eligible for
inclusion if they had suffered an acute severe stroke (Mobility Scale for Acute
Stroke </= 15). Physiotherapists assessed patients on day 3 poststroke,
collecting demographic information and information relating to their prestroke
status, social status and current status. Stepwise logistic-regression modelling
was used to examine the association between age, type of stroke, prestroke living
situation, comorbidities, availability of carer on discharge, current mobility,
bladder continence, bowel continence, cognition and communication and the
dependent variable, discharge destination (rehabilitation/other). The resulting
model was analysed using hierarchical logistic regression with hospital unit as
the clustering variable. Of the 108 patients fulfilling the inclusion criteria,
70 (64.8%) were discharged to rehabilitation. The variables independently
associated with discharge to rehabilitation were younger age [odds ratio
(OR)=0.89, 95% confidence interval (CI)=0.83-0.95, P=0.001], independent
premorbid functional status (OR=14.92, 95% CI=2.43-91.60, P=0.004) and higher
level of current mobility (OR=1.31, 95% CI=1.02-1.66, P<0.03). The multilevel
model estimated that 12% of the total variability in discharge destination was
explained by differences between the hospital units (rho=0.12, 95% CI=0.02-0.55,
P=0.048). The results indicate that the variables associated with discharge to
rehabilitation following severe stroke are younger age, independent prestroke
functional status and higher level of current mobility. In addition,
organizational factors play a role in selection for rehabilitation, suggesting
inequity in access for this patient group.

Langue : ANGLAIS