Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

PurposeTo examine the association of inpatient rehabilitation facility (IRF) length of stay (LOS) with stroke patient outcomes. DesignA secondary data analysis of the Uniform Data System for Medical Rehabilitation database. MethodsStroke patients discharged from IRFs in the United States between 2009 and 2011 were identified and divided into mild (n=639), moderate (n=2,065), and severely (n=2,077) impaired groups. Study outcomes included cognition and motor functional gains measured by the Functional Independence Measure (FIM) instrument and discharge to the community. FindingsThe average LOS was 8.9, 13.9, and 22.2days for mild, moderate, and severely impaired stroke patients, respectively. After controlling for FIM admission and other important covariates, a longer LOS was associated with a modest increase in cognition gain (=0.038, p=.0045) for the moderately impaired patients, and a modest increase in cognition (=0.13, p<.0001) and motor gains (=0.25, p<.0001) as well as a tendency for discharge to the community (OR=1.01, 95% CI=1.00-1.02) among the severely impaired patients. However, a longer LOS showed a negative association with functional gains among the mildly impaired patients as well as discharge to community for both mild and moderately impaired patients. ConclusionThe association of IRF LOS and patient outcomes varied by stroke impairment severity, positively for more severely impaired patients and negatively for mildly impaired patients. Clinical RelevanceThe study provides evidence for the care of stroke patients at the IRF setting.