Predicting institutionalization after Subacute Stroke Rehabilitation using the 12-Item World Health Organization Disability Assessment Schedule.
Sinikka Tarvonen-Schröder, Mari Koivisto
PMID 37548437WHAT IT FOUND
A 12-item disability questionnaire completed by caregivers at discharge accurately predicted which stroke patients would need institutional care.
Scores above 27.7 indicated a high likelihood of institutionalization. Participation limitations were as predictive as daily activity limitations, suggesting discharge planning should weigh social engagement heavily.
Key findings
01Proxy-completed WHODAS-12 scores had an area under the curve of 0.79 for predicting institutionalization, with a cut-off score of 27.7.
02The predictive accuracy of the proxy WHODAS-12 was equal to that of the modified Rankin Scale (AUC 0.79) and the WHO minimal generic data-set.
03Limitations in participation (such as household activities and joining in community) were as accurate in predicting institutionalization as limitations in activities (such as walking and self-care).
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 conducted in a single facility in Finland, so cultural and healthcare system differences may limit generalizability to other countries. The population was highly selected, consisting only of patients with major stroke (NIHSS ≥ 15) who had been living independently before the stroke. Results may not apply to patients with milder strokes or those who were already dependent. One-third of patients could not self-report due to severe impairment, meaning the primary predictive model relies entirely on proxy (caregiver) ratings, which may introduce bias. The design is cross-sectional at discharge, so it identifies associations and predictive value but cannot prove causation between disability levels and discharge destination.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume the patient's own self-report is the most accurate predictor. In this study, the predictive power was derived from proxy ratings because many patients could not respond. Additionally, do not overlook participation items; a patient may be physically capable of walking but still be institutionalized due to an inability to manage household tasks or engage in community life.