Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.

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  • dc.contributor.author Pérez, Laura M.ca
  • dc.contributor.author Inzitari, Marcoca
  • dc.contributor.author Quinn, Terence J.ca
  • dc.contributor.author Montaner, Joanca
  • dc.contributor.author Gavaldà, Ricardca
  • dc.contributor.author Duarte Oller, Estherca
  • dc.contributor.author Coll Planas, Lauraca
  • dc.contributor.author Cerdà, Mercèca
  • dc.contributor.author Santaeugenia, Sebastiàca
  • dc.contributor.author Closa, Conxitaca
  • dc.contributor.author Gallofré, Miquelca
  • dc.date.accessioned 2016-11-23T11:51:28Z
  • dc.date.available 2016-11-23T11:51:28Z
  • dc.date.issued 2016
  • dc.description.abstract BACKGROUND: Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. METHODS: We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient's classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes). RESULTS: Among 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54-8.63 and OR = 3.0, 95%CI = 1.52-5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81-10.75 and OR = 3.45, 95%CI = 1.31-9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65-17.03 and OR = 3.87, 95%CI = 1.69-8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23-0.75) and HCC (OR = 0.37, 95%CI = 0.19-0.73), for LOS lower Vs higher tertiles. CONCLUSION: Our data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.ca
  • dc.description.sponsorship This study was partially funded by the Generalitat de Catalunya.—Dr. Quinn is supported by a joint Stroke Association/Chief Scientist Office Senior Clinical Lecturer Fellowship. The mathematical analysis was supported by the projects SGR2014-890 (MACDA) of AGAUR (Agència de Gestió d’Ajuts Universitaris i de Recerca) and by MINECO (Ministry of Economy and Competitiveness) project APCOM
  • dc.format.mimetype application/pdfca
  • dc.identifier.citation Pérez LM, Inzitari M, Quinn TJ, Montaner J, Gavaldà R, Duarte E. et al. Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study. PLoS One. 2016 Nov 9;11(11):e0166304. doi: 10.1371/journal.pone.0166304ca
  • dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0166304
  • dc.identifier.issn 1932-6203
  • dc.identifier.uri http://hdl.handle.net/10230/27578
  • dc.language.iso engca
  • dc.publisher Public Library of Science (PLoS) ca
  • dc.relation.ispartof PLoS One. 2016 Nov 9;11(11):e0166304
  • dc.rights © 2016 Pérez et al/nThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ca
  • dc.rights.accessRights info:eu-repo/semantics/openAccessca
  • dc.rights.uri https://creativecommons.org/licenses/by/4.0/ca
  • dc.subject.other Infart de miocardi -- Pacientsca
  • dc.subject.other Persones gransca
  • dc.title Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.ca
  • dc.type info:eu-repo/semantics/articleca
  • dc.type.version info:eu-repo/semantics/publishedVersionca

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