Rehabilitation outcomes of patients with posterior circulation stroke after acute inpatient rehabilitation.

OBJECTIVE

We aim to describe functional outcomes, ambulation status, discharge disposition, and early return-to-work (RTW) at 3 months among patients with posterior circulation stroke (PCS) admitted to our acute inpatient rehabilitation unit.

DESIGN

This study employed a retrospective review of the medical records of patients.

SETTING AND

PARTICIPANTS

The study included patients with posterior circulation stroke who were discharged from the acute inpatient rehabilitation unit between 1 August 2018 and 1 April 2020, with a total of 72 patients identified.

INTERVENTIONS: Patients received inpatient rehabilitation in the acute inpatient rehabilitation unit.

MAIN OUTCOME MEASURES: Data collected included patients' biodata, impairments, length of stay (LOS) in the acute ward and acute inpatient rehabilitation ward, functional independence measure scores on admission and on discharge to acute inpatient rehabilitation ward, rehabilitation disposition, and return to employment.

METHODS

We conducted a retrospective cohort study of consecutive adults with CT/MRI-confirmed posterior circulation stroke who were discharged from the inpatient rehabilitation unit between 1 August 2018 and 1 April 2020. The hospital had onsite neurosurgery provision but no in-hospital endovascular thrombolysis service during the study period. Multidisciplinary rehabilitation included roughly 1 h/day of physiotherapy and 1 h/day of occupational therapy, with speech therapy when indicated and daily reviews by the rehabilitation medicine specialist. The main outcomes were LOS in both the acute and rehabilitation wards, functional independence measure (FIM) scores at admission and discharge, ambulation status at discharge and at 3 months, discharge disposition, and RTW at 3 months. Descriptive statistics were used and logistic regression analysis was performed for RTW, using IBM SPSS Statistics 25.

RESULTS

Seventy-two patients were included in the study. The LOS in the acute medical ward was 9.7 days, while the LOS in the rehabilitation ward was 17.8 days. The mean total FIM gain was 12.4, while FIM efficiency was 1.01/day. At discharge, 77.8% of patients returned home. By 3 months, 90.3% of patients were living at home, while 5.6% were in nursing homes. By 3 months, 59.7% achieved independent ambulation (with or without a walking aid), 36.1% walked with assistance, and 4.2% were non-ambulant. RTW at 3 months was observed in 11.1% of the cohort. Younger age (odds ratio (OR) 0.75; 95% CI 0.576-0.975; p = 0.031; lower odds of RTW with increasing age) and higher discharge total FIM scores (OR 1.20; 95% CI 1.02-1.40; p = 0.026) were associated with RTW.

CONCLUSIONS

In this retrospective study, structured inpatient rehabilitation was associated with functional gains in patients with posterior circulation stroke, and most patients were discharged home. Almost 60% achieved independent ambulation by 3 months. However, early RTW at 3 months was uncommon. These findings underscore the value of inpatient rehabilitation for PCS patients and highlight the ongoing need for gait or balance training and vocational rehabilitation pathways.