Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: a multi-centric study from intermediate care geriatric rehabilitation units of Catalonia.

Recovery after a stroke is determined by a broad range of neurological, functional and psychosocial factors. Evidence regarding these factors is not well established, in particular influence of cognition changes during rehabilitation. We aimed to investigate whether selective characteristics, including cognitive performance and its change over time, modulate functional recovery with home discharge in stroke survivors admitted to post-acute rehabilitation units. We undertook a multicenter cohort study, including all patients discharged from acute wards to any geriatric rehabilitation unit in Catalonia-Spain during 2008. Patients were assessed for demographics, clinical and functional variables using Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris (CMBD-RSS), which adapts the Minimum Data Set tool used in America's nursing homes. Baseline-to-discharge change in cognition was calculated on repeated assessments using the Cognitive Performance Scale (CPS, range 0-6, best-worst cognition). The multivariable effect of these factors was analyzed in relation to the outcome. 879 post-stroke patients were included (mean age 77.48 ± 10.18 years, 52.6% women). A worse initial CPS [OR (95% CI) = 0.851 (0.774-0.935)] and prevalent fecal incontinence [OR (95% CI) = 0.560 (0.454-0.691)] reduced the likelihood of returning home with functional improvement; whereas improvement of CPS, baseline to discharge, [OR (95% CI) = 1.348 (1.144-1.588)], more rehabilitation days within the first 2 weeks [OR (95% CI) = 1.011 (1.006-1.015)] and a longer hospital stay [OR (95% CI) = 1.011 (1.006-1.015)] were associated with the outcome. In our sample, different clinical characteristics, including cognitive function and its improvement over time, are associated with functional improvement in stroke patients undergoing rehabilitation. Our results might provide information to further studies aimed at exploring the influence of cognition changes during rehabilitation.

Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009 / Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009

Introducción: Describir la complejidad clínica de los pacientes al ingreso en unidades de larga estancia sociosanitaria en Cataluña entre los años 2003 y 2009. Material y métodos: Análisis transversal de 47.855 ingresos registrados en el sistema de información Conjunt Mínim Bàsic de Dades dels Recursos Sociosanitaris. Las variables analizadas fueron agrupaciones diagnósticas, las comorbilidades y los procedimientos médicos, estado funcional y cognitivo, categorías de uso de recursos del Resource Utilization Groups III (RUG-III), la cobertura y la intensidad de las terapias rehabilitadoras. Se realizó un análisis descriptivo de la información. Resultados: Las agrupaciones diagnósticas más frecuentes en el periodo de estudio fueron demencia y enfermedad cerebrovascular aguda, que mostraron un descenso continuado (descenso del 8,8 y el 2,3%). El mayor aumento correspondió a ingresos por descanso familiar y fractura (7,7% y 1,9%). El estado funcional y cognitivo promedio se mantuvo estable, aunque aumentó el porcentaje de individuos con dependencia en todas las actividades de la vida diaria. Las categorías RUG-III más frecuentes fueron rehabilitación, funciones físicas reducidas, complejidad clínica y cuidados especiales. Durante el periodo estudiado, la categoría «rehabilitación» se incrementó marcadamente (20,3%), mientras las otras categorías disminuyeron. Las terapias rehabilitadoras incrementaron su cobertura durante el periodo (20,8%), especialmente la fisioterapia (25,4%) y la terapia ocupacional (17,4%). Conclusiones: La complejidad clínica de la población atendida en unidades de larga estancia aumentó en el periodo 2003-2009. El uso de recursos y terapias indican un creciente esfuerzo rehabilitador, como posible respuesta a cambios en la complejidad clínica atendida, los estándares de práctica clínica o las prácticas establecidas en el registro y notificación de la información (AU)

Introduction: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. Material and methods: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. Results: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). Conclusion: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices (AU)

[Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009]. / Descripción del perfil de complejidad de los pacientes admitidos en unidades sociosanitarias de larga estancia entre los años 2003 y 2009.

INTRODUCTION: This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. MATERIAL AND METHODS: Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. RESULTS: Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). CONCLUSION: The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices.