Postacute Care Setting, Facility Characteristics, and Poststroke Outcomes: A Systematic Review.
Matthew Alcusky, Christine M Ulbricht, Kate L Lapane
PMID 28965738WHAT IT FOUND
Stroke patients rehabilitated in inpatient rehabilitation facilities were associated with lower mortality and often better community discharge than those in skilled nursing facilities, but functional gains were inconsistent and costs were higher.
Key findings
01In the two studies directly comparing community discharge, patients rehabilitated in IRFs were more likely to be discharged to the community than those rehabilitated in SNFs.
02All three studies comparing all-cause mortality estimated lower adjusted mortality risk for patients discharged to IRFs than for patients discharged to SNFs.
03Four studies compared functional outcomes: one favored SNFs over freestanding IRFs and IRFs within general hospitals, two favored IRFs, and the fourth favored IRFs for predicted and actual gains.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only observational studies; no experimental studies were found, so it cannot show that IRF care caused better outcomes. Only eight studies compared IRF and SNF outcomes, and their results were inconsistent for function and length of stay. Most studies used administrative data collected for other purposes, which can bias comparisons. Several studies used data from before IRF and SNF prospective payment systems, and the most recent outcome-comparison data were 7 years old at review. Facility-level evidence was thin: six of seven facility studies focused only on IRFs, and few SNF factors were studied. No study evaluated quality of life, an outcome stroke patients may care about. Patients were differentially selected into IRFs and SNFs; older age was seen in SNF patients in all seven studies reporting age, and adjustment could not remove all unmeasured differences.
Declared interests
No conflicts of interest were declared. The supplied publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that IRFs cause better stroke recovery. The review found associations in observational studies, patients were selected differently by setting, and functional outcomes were inconsistent.