Reduced Functional and Quality of Life Outcomes Associated With Delays in Evaluation for Acute Rehabilitation Services

Objective(s): To assess the impact of delays in evaluation for rehabilitation services on disability and health-related quality of life (HRQoL) after ischemic stroke and transient ischemic attack (TIA). Design: Rehabilitation evaluations (i.e., PT: physical therapy; OT: occupational therapy) were obtained from a retrospective chart review and HRQoL measures from a longitudinal observational study of poststroke outcomes. Setting: Stroke Center provided rehabilitation-related data. Participants in the community provided HRQoL data. Participants: Individuals post-stroke (nZ420) who underwent physical or occupational therapy evaluations. The sample was on average 66.2 years old (SDZ15.7), was largely white (64.1%); 47.4% were female, and 13.3% had a TIA diagnosis. Interventions: Usual rehabilitation services. Main Outcome Measure(s): Modified Rankin Scale (mRS) at 1 and 3months post-stroke and Neurological Quality of Life (NeuroQoL) measures of upperand lower-extremity physical function, general cognitive concerns, and executive function. Results: The mean number of days between hospital admission to evaluation (i.e., delay) was 3.2 (SDZ2.9) for PT and 4.4 (SDZ4.5) for OT. After controlling for age, stroke severity and stroke subtype, each additional day of delay resulted in higher levels of disability (mRS: PT, bZ0.06, p<0.01; OT, bZ0.08, p<0.001) and additional decrements in physical function (Upper Extremity: OT, bZ-0.37, p<0.01; Lower Extremity: PT, bZ-0.47, p<0.05; OT, bZ-0.57, p<0.001) and cognitive function (Executive Function: PT, bZ-0.65, p<0.01; OT: bZ-0.84, p<0.001; General Concerns: PT, bZ-0.54, p<0.01; OT, bZ-0.47, p<0.001) at 1-month post-stroke. All effects were maintained at 3-months for OT only. Conclusions: Long-term disability after stroke is associated with delayed evaluation for rehabilitation services. In order to reduce long-term disability, early evaluation should be implemented, but the appropriate timing to initiate rehabilitation post-stroke is still unknown.