Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke

Abstract Background This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility‐Patient Assessment Instrument (IRF‐PAI), and community discharge from IRF. Objectives Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF‐PAI self‐care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF‐PAI admission functional measures to predict community discharge from IRF after stroke. Design Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019. Setting Academic hospital‐based IRF. Participants Five hundred forty‐four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hours of IRF admission. Interventions Not applicable. Main Outcome Measures Admission IRF‐PAI self‐care and mobility scores and discharge status from IRF. Results Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF‐PAI admission self‐care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF‐PAI admission mobility score. IRF admission self‐care and mobility scores were each statistically significant predictors of community discharge (odds ratio OR = 1.10, 95% confidence interval CI: 1.03–1.17; OR = 1.10, CI: 1.03–1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47–1.04) from IRF. Conclusions IRF‐PAI self‐care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF‐PAI self‐care and mobility measures each predict community discharge.