OCT 03, 2016

Interruptions to Stroke Rehab Could be Prevented

WRITTEN BY: Brenda Kelley Kim

Globally, about 15 million people will suffer a stroke each year. 1/3 will die, 1/3 will be left disabled and the other 1/3 will eventually recover. That recovery however, is often long and difficult. It’s not uncommon for it to be interrupted as well, whether from further complications, illness or other medical issues. This is where some patients, who may have been on their way to full recovery, will fall into the group left with permanent disability. A new study published in the American Journal of Physical Medicine & Rehabilitation shows that roughly ten percent of interruptions to rehab might have been prevented.

The most recent research on rehab and how interruptions affect it was conducted by Addie Middleton, PhD, DPT and colleagues at the University of Texas Medical Branch, Galveston. The study, “Program Interruptions and Short-Stay Transfers Represent Potential Targets for Inpatient Rehabilitation Care-Improvement Efforts” analyzed Medicare data for patients undergoing neurological rehabilitation for three different conditions. Stroke accounted for 72,000 cases of patient data examined, while 7, 100 cases of traumatic brain injury (TBI) and 660 cases of spinal cord injury (SCI) were part of the study. All of the patients were admitted to their rehabilitation facility directly after being discharged from the hospital where they had initially been treated.

While the type of medical event that resulted in the patients being admitted to rehab was important in the study, the type of interruption mattered as well. The team focused on unplanned interruptions of rehab treatment. The first was an interruption where a patient had to be transferred to another facility for some medical reason, but was back at rehab within 3 days and a longer interruption called a “short stay” transfer where the patient had to be admitted to another facility or hospital for more than three days.

In general, about 1% of all patients in rehab will experience an interruption in their program. Usually it’s the result of a complication and the transfer out of rehab is usually to an acute care hospital. If a patient is able to get back to rehab quickly, there is usually a better outcome. The research in this study showed however, that patients who were in the short-stay category and away from rehab for a longer time didn’t do as well. In about ten percent of these cases, the interruption likely could have been prevented. Preventable causes of short-term transfers included problems like dehydration, heart failure, pneumonia, and urinary tract infections.

Rehabilitation from any kind of neurological condition is not only difficult but it is costly as well. That’s why this kind of therapy is often studied to see where costs can be reduced and improvements in care can be made. This study is one of the first to look at interruptions in care, rather than the care itself. In the study, the authors conclude that, “Reducing rates of program interruptions and short-stay transfers will not just improve patient experiences of care, they will likely also translate to lower Medicare spending per beneficiary.” The video below explains more about the study.

Sources: UPI, National Institute of Neurological Disorders and Stroke
American Journal of Physical Medicine & Rehabilitation , RehabPub