Delaying admission to inpatient rehabilitation worsens outcome for stroke patients: Detrimental impact of COVID-19 on stroke survivors

ABSTRACT

Introduction: Inpatient rehabilitation (IPR) is crucial to recovery after stroke. COVID-19, however, has led to delays in post-stroke admission to IPR due to transmission concerns. Objective: We evaluated the effect of time from stroke onset to IPR admission on post-stroke recovery Design: A retrospective analysis of 680 patients with acute stroke or intracerebral hemorrhage (ICH), admitted to IPR between APR-2017 and AUG-2019. Association between time from stroke onset to IPR and discharge FIM-Motor Total and FIM-Motor Total with transfers scores was studied, after adjusting for sex, age at onset, stroke severity and type. Multiple linear regression models were conducted for outcomes discharge (FIM-Motor Total) and (FIM-Motor Total with transfers) (Table 1). Square transformations were used to satisfy model assumptions. Ordinal logistic regression models were run for outcomes discharge FIM subset scores categorized as independent (6-7), needs supervision (5), and needs assistance (1-4, reference). The primary variable of interest was days onset to IPR, adjusted for stroke severity (admit FIM subset scores), sex, stroke type and age. (Table 2). The proportional odds assumption was verified using Brant test. Results: An inverse relationship was observed between days from onset to IPR and discharge FIMMotor with and without transfers. Time from stroke onset to IPR admission was associated with decreased discharge FIM-Motor and FIM-Motor with transfers, after adjusting for other covariates. Among FIM subset discharges, an additional day also resulted in a 2-5% decrease in the odds of being more independent. Conclusion: Delays to IPR admission result in decreased motor function gains and lower chance of independence. In addition to current community education practices, acute care hospitals and IPR facilities must review their processes to remove delays. These processes include requirements for COVID disease testing and IPR acceptance policies.