Delayed inpatient rehabilitation and functional outcomes for acute stroke: a retrospective cohort study in an Australian regional hospital.

Abstract

The impact of delayed inpatient rehabilitation on the functional outcomes of stroke patients has not been reported in regional Australia. This study examined the impact of delayed inpatient rehabilitation following acute stroke on functional outcomes (Relative Functional Gain and Functional Independence Measure efficiency) and length of stay in rehabilitation at a regional Australian hospital. Rehabilitation initiated > 24 h after a patient was deemed clinically ready was considered delayed. Associations between delayed inpatient rehabilitation and functional outcomes were investigated with mixed effects linear regression while length of stay was modelled using a negative binomial regression. Of a total 487 patients, 301 (61.8%) experienced delayed inpatient rehabilitation, with a median delay of 2 days (interquartile range: 1-4 days). Multivariate regressions showed delayed inpatient rehabilitation was negatively associated with Relative Functional Gain (Beta: -0.07, 95% confidence interval [CI]: -0.11, -0.02, p = 0.009) and Functional Independence Measure efficiency (Beta: -0.18, 95% CI: -0.32, -0.04, p = 0.014), but positively associated with length of stay in rehabilitation wards (incidence rate ratio: 1.11, 95% CI: 1.02, 1.21, p = 0.021). Bed unavailability was the leading cause of delay. Delayed inpatient rehabilitation is associated with poorer functional outcomes in stroke patients. Timely access to rehabilitation is crucial for optimising recovery.