Is the Activity Measure for Postacute Care "6-Clicks" Tool Associated With Discharge Destination Postacute Stroke?
Heather Anne Hayes, Robin Marcus, Gregory J Stoddard and 3 others
PMID 36545521WHAT IT FOUND
In 721 people after ischemic stroke, higher mobility and daily-activity scores near discharge were associated with going home rather than a facility.
The same scores did not distinguish inpatient rehab from skilled nursing.
Key findings
01In the 721-person cohort, higher mobility and daily-activity scores recorded within 24 hours before discharge were associated with going home rather than a postacute care facility.
02The comprehension/memory score was not associated with discharge to a facility after adjustment.
03For people sent to a facility, the AM-PAC scores did not discriminate between inpatient rehabilitation and skilled nursing.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was done in one hospital system, so it may not apply to other hospitals or regions. It used existing electronic records, so data could be inaccurate, omitted, or limited to categories rather than clinical detail. The paper reports NIHSS missing for 222 of 731 records, accounting for 30.8% of the data, although the analysis used multiple imputation. People discharged to long-term care or hospice, people who died, people who left against medical advice, prisoners, and duplicate strokes were excluded. The study describes actual discharge decisions under usual care, not the best discharge decision for each patient. It reports associations with records, not proof that the AM-PAC scores caused the placement.
The easy way to misread this
Do not use the 6-Clicks scores to choose between inpatient rehabilitation and skilled nursing. The mobility, daily-activity, and comprehension/memory scores did not discriminate between these two facility types.