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Effectiveness of Hospital-based Outpatient Stroke Rehabilitation
e36 Research Poster 3434 Predicting Discharge Destination with Admission Outcomes Following Stroke Sheila Rosenberg (Casa Colina Hospital and Centers for Healthcare), Debra Ouellette, Cathelyn Timple, Stephanie Kaplan, Emily Rosario Objective(s): To use inpatient rehabilitation facility (IRF) admission outcomes for patients with stroke to predict discharge destination. Design: Retrospective survey study. Setting: Inpatient Rehabilitation Hospital. Participants: Patients (NZ407) hospitalized for an acute stroke. Patients were included in the study if they had a stroke within 6 months of admission to rehabilitation. Patients were excluded if the time between onset and admission was greater than 6 months or if they had a previous stroke. Interventions: N/A. Main Outcome Measure(s): Admission data from the Functional Independence Measure (FIM) and Simplified Stroke Rehabilitation Assessment of Movement (S-STREAM) were used to determine predictive factors for a community discharge. Results: Admission variables that predict discharge destination were identified using logistic regression analysis. Logistic regressions and chi-square analysis were then used to determine the cut off score for each predictive variable and to create a predictive tool. Specifically a score of 12 and above on the S-STREAM, 26 and above on Motor FIM, 47 and above on Total FIM, and 3 and above for the following individual FIM items: FIM Bladder, FIM bed transfer, FIM toilet transfer, FIM bathing, and FIM memory were all predictive of a community discharge. The predictive tool with the greatest sensitivity and specificity combined 4 admission variables (S-STREAM, FIM Bladder, FIM Bed transfer, and FIM memory) and was able to predict a community discharge with a sensitivity of 76% and a specificity of 64%. Conclusions: By using admission outcomes, discharge destination can be predicted with significant sensitivity and specificity. A predictive tool for discharge destination has clinical utility in identifying appropriate patients for acute rehabilitation and in determining the best plan of care for patients at risk of an institutional discharge. Prospective evaluation of this predictive tool is warranted. Key Words: Stroke, Stream, FIM, Community discharge, Outcomes Disclosure(s): None Disclosed. Research Poster 3435 Effectiveness of Hospital-based Outpatient Stroke Rehabilitation Danielle Brittany Rice (Lawson Health Research Institute), Shannon Janzen, Amanda McIntyre, Eileen Britt, Robert William Teasell Objective(s): To assess the effectiveness of a hospital-based outpatient stroke rehabilitation program. Design: Retrospective chart review. Setting: Hospital-based outpatient stroke rehabilitation program in Southwestern Ontario. Participants: Individuals post stroke who attended the Comprehensive Outpatient Rehabilitation Program (CORP) between January 1, 2010 and March 31, 2014. Interventions: N/A. Main Outcome Measure(s): Functional Independence Measure (FIM), nine hole peg test, grip strength, three point pinch, lateral pinch, Chedoke McMaster Stroke Assessment, two-minute walk test, greatest distance walked, timed up and go, Berg Balance scale, one-legged stance, Chessington Occupational Therapy Neurological Assessment Battery, Community Balance and Mobility Scale, Boston Naming Test, Western Aphasia Naming and Quotient subscales and Reading Comprehension Battery for Aphasia. Results: In total, 471 outpatients attended therapy (56.3% male, mean age 60.11+15.19 years), the majority of which were referred for physiotherapy
Research Posters (69.4%) and/or occupational therapy (68.6%). Mean patient FIM gains were 3 points between admission and discharge scores. Significant improvements between admission and discharge scores were found for all outcomes (p<0.002) except for the nine hole peg test, three point pinch and lateral pinch outcome measures (p>0.05 for all). Compared to individuals with FIM gains in the 0-75th percentile, those above this threshold were enrolled in CORP for an average of six additional weeks. Those enrolled in CORP for a significantly greater length of time (t (249) Z -3.47, pZ0.001) made the most FIM gains. Conclusions: This outpatient program was effective at improving the functional, cognitive and language recovery of patients after stroke. A hospital-based, stroke-specific multidisciplinary outpatient rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Key Words: Stroke, Rehabilitation, Outpatients Disclosure(s): None Disclosed. Research Poster 3439 Correlates of Depressive Symptoms in Stroke Outpatients Danielle Brittany Rice (Lawson Health Research Institute), Amanda McIntyre, Julianne Vermeer, Ricardo Viana, Steven Macaluso, Robert William Teasell Objective(s): To determine independent predictors for depressive symptomology in a sample of individuals attending stroke outpatient clinics. Design: Retrospective chart review. Setting: Hospital-based outpatient stroke clinic in Southwestern Ontario. Participants: Individuals post stroke who attended one of three outpatient clinics between January 1, 2014 and December 31, 2014. Interventions: N/A. Main Outcome Measure(s): Patient Health Questionnaire-9 (PHQ-9), Montreal Cognitive Assessment (MoCA) and self-reported patient deficits. Results: In total, 226 outpatients attended the stroke clinic (53% male; mean age 65.214.9 years; mean time post stroke 14.620.1 months). Pre-stroke depression was reported in 5.8% of the patients, while 33% of patients reported mild to severe depressive symptoms at their outpatient visit (PHQ-95). Variables including smoking, cognitive impairment (CI) and pain were significantly related to reporting depressive symptoms (p<0.01) while age and gender were not. The regression model correctly classified 71% of cases with depressive symptoms. The strongest predictor of depressive symptoms was current CI; as those with CI were four times more likely to score highly on the PHQ-9 than those who did not report CI (ORZ4.32). The MoCA also objectively measured CI and was negatively related to depressive symptoms while controlling for age, with higher PHQ-9 scores correlated to lower MoCA scores (rZ -0.38, p<0.005). Conclusions: High levels of depressive symptoms are common in the chronic phase post stroke and were partially related to cognitive-sensory deficits and lifestyle factors. Interventions to treat CI and pain, along with lifestyle modification, may assist in improving mood. Key Words: Stroke, Depression, Outpatients Disclosure(s): None Disclosed. Research Poster 3440 Self-Identified Needs and Priorities of Rehabilitation Outpatients with Brain Cancer and Their Family Carers Chris Tripp (Courage Kenny Rehabilitation Institute), Traci Anderson, Mary Vining Radomski Objective(s): To describe self-identified needs and outcome aspirations of rehabilitation outpatients with brain cancer and their family carers in order to improve rehabilitation planning. Design: We employed qualitative methods involving semi-structured telephone interviews that were audio recorded and transcribed verbatim. Inductive analysis was used to identify patterns, themes, and categories. Setting: Outpatient rehabilitation services within a large medical system.
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Research Posters (69.4%) and/or occupational therapy (68.6%). Mean patient FIM gains were 3 points between admission and discharge scores. Significant improvements between admission and discharge scores were found for all outcomes (p<0.002) except for the nine hole peg test, three point pinch and lateral pinch outcome measures (p>0.05 for all). Compared to individuals with FIM gains in the 0-75th percentile, those above this threshold were enrolled in CORP for an average of six additional weeks. Those enrolled in CORP for a significantly greater length of time (t (249) Z -3.47, pZ0.001) made the most FIM gains. Conclusions: This outpatient program was effective at improving the functional, cognitive and language recovery of patients after stroke. A hospital-based, stroke-specific multidisciplinary outpatient rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Key Words: Stroke, Rehabilitation, Outpatients Disclosure(s): None Disclosed. Research Poster 3439 Correlates of Depressive Symptoms in Stroke Outpatients Danielle Brittany Rice (Lawson Health Research Institute), Amanda McIntyre, Julianne Vermeer, Ricardo Viana, Steven Macaluso, Robert William Teasell Objective(s): To determine independent predictors for depressive symptomology in a sample of individuals attending stroke outpatient clinics. Design: Retrospective chart review. Setting: Hospital-based outpatient stroke clinic in Southwestern Ontario. Participants: Individuals post stroke who attended one of three outpatient clinics between January 1, 2014 and December 31, 2014. Interventions: N/A. Main Outcome Measure(s): Patient Health Questionnaire-9 (PHQ-9), Montreal Cognitive Assessment (MoCA) and self-reported patient deficits. Results: In total, 226 outpatients attended the stroke clinic (53% male; mean age 65.214.9 years; mean time post stroke 14.620.1 months). Pre-stroke depression was reported in 5.8% of the patients, while 33% of patients reported mild to severe depressive symptoms at their outpatient visit (PHQ-95). Variables including smoking, cognitive impairment (CI) and pain were significantly related to reporting depressive symptoms (p<0.01) while age and gender were not. The regression model correctly classified 71% of cases with depressive symptoms. The strongest predictor of depressive symptoms was current CI; as those with CI were four times more likely to score highly on the PHQ-9 than those who did not report CI (ORZ4.32). The MoCA also objectively measured CI and was negatively related to depressive symptoms while controlling for age, with higher PHQ-9 scores correlated to lower MoCA scores (rZ -0.38, p<0.005). Conclusions: High levels of depressive symptoms are common in the chronic phase post stroke and were partially related to cognitive-sensory deficits and lifestyle factors. Interventions to treat CI and pain, along with lifestyle modification, may assist in improving mood. Key Words: Stroke, Depression, Outpatients Disclosure(s): None Disclosed. Research Poster 3440 Self-Identified Needs and Priorities of Rehabilitation Outpatients with Brain Cancer and Their Family Carers Chris Tripp (Courage Kenny Rehabilitation Institute), Traci Anderson, Mary Vining Radomski Objective(s): To describe self-identified needs and outcome aspirations of rehabilitation outpatients with brain cancer and their family carers in order to improve rehabilitation planning. Design: We employed qualitative methods involving semi-structured telephone interviews that were audio recorded and transcribed verbatim. Inductive analysis was used to identify patterns, themes, and categories. Setting: Outpatient rehabilitation services within a large medical system.
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