Standardized scores accurately recommend stroke patient's placement after discharge

Meta-analyses of five large-scale studies have proven the efficacy of standardized rating scales in determining a stroke patient’s placement after hospital discharge, according to research published in the January issue of the Journal of Neurological Physical Therapy.

Two measures used to assess post-stroke functionality and recovery—the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS)—have been widely used as indicators of a patient’s progress after suffering stroke, first author Emily Thorpe, PT, DPT, and colleagues at Walsh University in Ohio wrote. However, FIM and NIHSS are more likely to be used simply to quantify a patient’s abilities and clinical conditions rather than to determine a discharge location.

Thorpe et al. evaluated data from more than 6,000 stroke patients and five studies for their analysis, four of which evaluated FIM and two of which used NIHSS. The researchers found both scales to be fair indicators of discharge destination.

For every one-point improvement in a patient’s FIM score, Thorpe and co-authors reported, patients were around 8 percent more likely to be sent straight home from the hospital rather than rerouted to a care facility like a rehabilitation center or nursing home.

In both the FIM and NIHSS measures, patients who scored above average were 12 times more likely to be discharged to their home, while those with average scores were 1.9 times more likely to be recommended for speciality care. Patients with poor scores on both scales were 3.4 times more likely to be sent to a care facility.

Post-stroke rehab isn’t uncommon or frowned upon. Rather, as spending for stroke recovery increases and the at-risk population grows older, it is “more important than ever to provide efficient care for patients recovering from a stroke,” according to a release from Wolters Kluwer Health. Around 20 percent of all stroke survivors require institutionalized care beyond three months, the release read, and many also need additional at-home care once they return to their daily lives.

“Findings from these meta-analyses are consistent with common sense practice: the better a patient’s outcome measure score, the greater the likelihood of home discharge,” Thorpe and colleagues wrote in the study. “Ultimately, standardized outcome measures should be further used and studied among the post-stroke population to improve healthcare policy and complement clinical judgment in the task of recommending discharge destinations for patients to receive the necessary care for achieving their optimal function.”