Key result
Severe post-stroke disability is linked to ~95% lower 90-day home-time compared with no disability.
Cohort (n=39,417)
Yes
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OBJECTIVE: Home-time is an emerging patient-centred stroke outcome metric, but it is not well described in the population. We aimed to determine the association between 90-day home-time and global disability after stroke. We hypothesised that longer home-time would be associated with less disability. DESIGN: Hospital-based cohort study of patients with ischaemic stroke or intracerebral haemorrhage admitted to an acute care hospital between 1 April 2002 and 31 March 2013. SETTING: All regional stroke centres and a simple random sample of patients from all other hospitals across the province of Ontario, Canada. PARTICIPANTS: We included 39 417 adult patients (84% ischaemic, 16% haemorrhage), 53% male, with a median age of 74 years. We excluded non-residents of Ontario, patients without a valid health insurance number, patients discharged against medical advice or those who failed to return from a pass, patients living in a long-term care centre at baseline and stroke events occurring in-hospital. PRIMARY OUTCOME MEASURE: Association between 90-day home-time, defined as the number of days spent at home in the first 90 days after stroke, obtained using linked administrative data and modified Rankin Scale score at discharge. RESULTS: Compared with people with no disability, those with minimal disability had less home-time (adjusted rate ratio (aRR) 0.96, 95% CI 0.93 to 0.98) and those with the most severe disability had the least home-time (aRR 0.05, 95% CI 0.04 to 0.05). We found no clinically relevant modification by stroke type, sex or study year. However, for a given level of disability, older patients experienced less home-time compared with younger patients. CONCLUSIONS: Our results provide content validity for home-time to be used to monitor stroke outcomes in large populations or to study temporal trends. Older patients experience less home-time for a given level of disability, suggesting the need for stratification by age.
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Yu et al. (2019) conducted a cohort in Ischaemic stroke or intracerebral haemorrhage (n=39,417). Global disability after stroke (modified Rankin Scale score at discharge) vs. No disability was evaluated on 90-day home-time (number of days spent at home in the first 90 days after stroke) (aRR 0.05 (most severe disability vs no disability), 95% CI 0.04-0.05). Higher post-stroke disability was associated with reduced 90-day home-time compared with no disability, ranging from aRR 0.96 (95% CI 0.93-0.98) for minimal to 0.05 (95% CI 0.04-0.05) for most severe.
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