Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke.

OBJECTIVE Delayed admission to rehabilitation may result in poorer outcomes by reducing exposure to therapeutic interventions at a time when the brain is primed for neurological recovery. The present study examined the effects of early vs delayed admission on functional outcome and length of stay in patients admitted to a rehabilitation unit for first-ever unilateral stroke. DESIGN Retrospective chart review. METHODS Differences in length of rehabilitation stay and functional outcome variables among 435 patients, grouped by interval from stroke event to rehabilitation admission (=30 days vs 31-150 days and 5 additional subgroups) were examined using a multivariate technique. RESULTS Admission and discharge FIM scores, FIM change and FIM efficiency were significantly higher among early admission patients (p<0.01), while length of stay was significantly longer among delayed admission patients (p<0.01). A significant association was identified between age and admission (p<0.01) and discharge FIM (p<0.01) scores as well as FIM change scores (p=0.017). Subgroup analyses revealed significant differences in FIM scores, FIM change and length of stay between groups of patients admitted 0-15 and 16-30 days (p<0.01) and between patients admitted 16-30 days and 31-60 days post-stroke (p<0.01). No significant differences were noted between patients admitted from 31-60 and 61-90 or 61-90 and 91-150 days. CONCLUSION Patients admitted to stroke rehabilitation within 30 days of first-ever, unilateral stroke experienced greater functional gains and shorter lengths of stay than those whose admission to rehabilitation was delayed beyond 30 days.