Potential factors, including activities of daily living, influencing home discharge for patients with putaminal haemorrhage

Association between oral health status and functional independence measure on admission in convalescent hospitalized patients

BACKGROUND

Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period.

METHODS

We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%.

RESULTS

The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42-97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns.

CONCLUSIONS

The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement.

Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation.

DATA SOURCES

A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023.

METHODS

Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data.

RESULTS

Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination.

CONCLUSION

This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.

The Association between Oral Health Management and the Functional Independence Measure Scores at the Time of Admission of Inpatients to a Convalescent Hospital

Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.

Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Cognitive function is associated with home discharge in subacute stroke patients: a retrospective cohort study

Aim

To investigate the cognitive function and its relation to the home discharge of patients following subacute stroke.

Methods

This retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge.

Results

Of the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 – 0.96; P < 0.001), duration from stroke onset to admission (OR, 0.98; 95% CI, 0.96 – 0.99; P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 – 7.20; P < 0.001), MMSE score at admission (OR, 1.05; 95% CI, 1.00 – 1.09; P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 – 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 – 1.13; P < 0.001) were significantly associated with home discharge.

Conclusions

MMSE at admission is significantly associated with home discharge in patients with subacute stroke.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-022-02745-8.

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis

PURPOSE

To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives.

METHODS

We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status.

RESULTS

Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01; 95%CI 7.38-130.18).

CONCLUSION

Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status.IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning.Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home.To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission.Further predictive factors for discharge home are cohabitation and marital status.

What activities of daily living at discharge affect the discharge destination of patients in an acute-care hospital in Japan: A retrospective factor analysis

It is important to clarify the influence of activities of daily living (ADL) at discharge on the discharge destination of hospitalised patients. The Functional Independence Measure (FIM) is a widely used ADL assessment scale. In this retrospective study, we aimed to identify what ADL based on FIM at discharge affect the discharge destination of hospitalised patients in an acute-care hospital, in addition to how nutritional status and the number of drugs used, as well as types of disease, affect discharge-to-home. We surveyed age, sex, disease type, length of hospital stay, discharge destination, FIM score at discharge, serum albumin level, and the number of continued drugs in hospitalised patients who underwent rehabilitation in Gifu Municipal Hospital (Gifu, Japan) between January 2014 and December 2014. Multiple logistic regression analysis was performed with discharge to home as a dependent variable and age, sex, disease, FIM score and polypharmacy as independent variables. Multiple logistic regression analysis indicated that a significantly high percentage of discharged-to-home patients were associated with 'self-care' (≥33 points; OR: 2.03), 'sphincter control' (≥14 points; OR: 1.49), 'transfers' (≥13 points; OR: 1.94), and 'locomotion' (≥7 points; OR: 3.55), among others. High FIM sub-scale scores at discharge for self-care, sphincter control, transfers, and locomotion were clarified as factors associated with discharge-to-home. These findings of the association of ADL based on FIM and discharge destination would be useful in deciding discharge destinations for patients in an acute-phase hospital.

Influence of hematoma volume and age on cognitive functions and ADL after putaminal hemorrhage

BACKGROUND AND OBJECTIVE

After cerebral hemorrhage, cognitive functions and activities of daily living (ADL) are affected by various factors, including hematoma volume and patient age. In the present study, we investigated the effect of age and hematoma volume on cognitive functions and on ADL.

METHODS

The sample comprised 274 patients (183 men and 91 women; mean age 58.2 ± 12.5 years) with putaminal hemorrhage who were hospitalized in a convalescent rehabilitation ward. Hematoma volume was estimated from computed tomography imaging at stroke onset. Cognitive functions were evaluated using Raven's Colored Progressive Matrices test (RCPM) and the Mini-Mental State Examination (MMSE) at hospital admission, while ADL score was assessed at discharge using the Functional Independence Measure motor subscale (FIM-M). In the present study, we classified the patients into six groups according to whether they were non-elderly or elderly (cutoff age, 60 years) and whether their hematoma was small, medium, or large (cutoff volumes, 20 and 40 mL, respectively). Subsequently, the scores on the RCPM, MMSE, and FIM-M were compared among the groups.

RESULTS

In both age groups, patients with a larger hematoma volume had lower RCPM and MMSE scores. Patients <60 years old exhibited different trends in their RCPM and MMSE scores, such that the RCPM score showed a step-wise decrease according to hematoma volume, while a difference in the MMSE score was only observed at the 20 mL boundary. Most of the younger patients (<60 years of age) attained high FIM-M scores at discharge, as long as their hematoma volume was either medium or small (<40 mL). This age group had higher RCPM scores on admission, which may have contributed to their higher FIM-M scores on discharge.

CONCLUSIONS

In the present study, we demonstrated that advancing age increases the effect of hematoma volume on RCPM and MMSE scores and identified differences in the effects observed on these two scores. Thus, it may be important to use the RCPM alongside the MMSE for patient assessment.

Effects of nutritional status on prognosis in patients with severe hemiplegia who were recently admitted to a rehabilitation hospital

[Purpose] The purpose of this study was to examine the effect of nutritional status on the prognosis of patients with severe hemiplegia who were recently admitted to a convalescent rehabilitation hospital. [Participants and Methods] Eighty patients with stroke and severe hemiplegia were divided into two groups based on their serum albumin levels: normal (serum albumin 3.5 g/dL or more) and undernourished group (serum albumin 3.4 g/dL or less). Background characteristics, cognitive function, neurological symptoms, physical function at admission, and outcome were compared between groups. [Results] There were no differences found between groups in terms of cognitive function, neurological symptoms, physical function at admission, destination, and length of stay at the hospital. In contrast, age and duration from onset to admission were significantly lower in the normal group than in the undernourished group. The ability to walk and perform activities of daily living (ADL) at discharge was significantly higher in the normal group than in the undernourished group. [Conclusion] As a result, the findings of the present study suggest that in patients with severe hemiplegia, nutritional status at the time of admission determines the improved walking and ADL ability at the time of discharge.

Development and validation of a prediction model for home discharge in patients with moderate stroke: The Korean stroke cohort for functioning and rehabilitation study

BACKGROUND

Previous studies have investigated the predictors for home discharge without considering stroke severity.

OBJECTIVES

To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals.

METHODS

Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model.

RESULTS

The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90).

CONCLUSIONS

This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients.

Outcomes for older adults in inpatient specialist neurorehabilitation

BACKGROUND

Inpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to "working-age" adults (<65 years), with little evidence for outcomes for older adults involved with these services.

OBJECTIVE

The aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.

METHODS

A two-centre retrospective review was performed comparing patients aged<65 and≥65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure+Functional Assessment Measure (UK FIM+FAM) scores and discharge destination.

RESULTS

Six hundred and sixteen patients (32%≥65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] -2 to 15, P=0.112), but both UK FIM+FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2-13, P=0.006 and 0.10, 0.01-0.19, P=0.031 respectively). Older age was associated with discharge to long-term care (6%<65 years; 11%≥65 years, x²=4.10, P=0.043). Results and trends were similar in patients with acquired brain injury (n=429), spinal cord injury (n=59) and peripheral neuropathy (n=34) but not progressive neurological disorders (n=70).

CONCLUSION

Older adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.

Activities of daily living independence level for home discharge in stroke patients based on number of caregivers: an analysis of the Japan Rehabilitation Database

Purpose This study aimed to calculate cut-off values of activities of daily living independence level for stroke patient home discharge based on the number of family caregivers. Method The subjects comprised 1442 stroke patients (26 hospitals) who were registered of the Japanese Rehabilitation Database. Receiver operating characteristic curves were used to elucidate the BI and FIM^Ⓡ instrument scores necessary for home discharge. Analysis was performed for each subject according to the number of family caregivers, i.e., no caregiver, one person, two persons or more, and overall. Result The BI cut-off points that discriminated between home discharge and other were 65/60 points overall, 75/70 points in patients with no caregiver, 65/60 points in patients with one caregiver, and 60/55 points in patients with two or more caregivers. The FIM^Ⓡ instrument cut-off points were 90/89 points overall, 101/100 points in patients with no caregiver, 87/86 points in patients with one caregiver, and 87/86 points in patients with two or more caregivers. Conclusion Our results indicated that home discharge for patients with many caregivers was possible even with low ADL independence levels, and that there was a large difference in cut-off values depending on the presence or absence of one caregiver.

Intravascular Lymphoma with an Acute Course of Cerebellar Hemorrhage: A Case Report

Intravascular lymphoma (IVL) has been characterized in many case reports by multiple white matter lesions reflecting ischemic changes. In contrast, there are very few case reports of cerebral or cerebellar hemorrhage resulting from IVL. A 56-year-old woman was referred to our department with two-week history of headache, nausea, and poor appetite. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) showed dilated veins on the cerebellar surface. No ischemic lesions were detected on diffusion-weighted images. Three days after admission, the patient had a large cerebellar hemorrhage, prompting emergency surgery. Unfortunately, the patient died on the 11th postoperative day. Massive CD20-positive lymphoma cells were recognized in the cerebellar veins, but not in the arteries or the parenchyma of the brain. This is the rare case report of a cerebellar hemorrhage complication from IVL that might have been caused by venous congestion. The dilated veins on the cerebellar surface recognized from the Gd-enhanced T1-weighted images were specific clues in this case.