# PREDICTION OF LONG-TERM FUNCTIONAL OUTCOME FOLLOWING DIFFERENT REHABILITATION PATHWAYS AFTER STROKE UNIT DISCHARGE

## TL;DR

This study found that home-based or outpatient rehabilitation after stroke leads to better long-term outcomes compared to inpatient rehabilitation.

## Contribution

The study identifies that rehabilitation pathway type can predict long-term functional outcomes after stroke.

## Key findings

- Planned outpatient rehabilitation predicted independence at 1 year post-stroke.
- Home-based rehabilitation predicted independence at both 1 and 5 years post-stroke.
- Inpatient rehabilitation was associated with more severe initial conditions and did not predict independence.

## Abstract

To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke.

A longitudinal and registry-based study.

A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke.

Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category.

Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence.

Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1–5 years. This may have been due to the less severe nature of these participants’ conditions, compared with those requiring inpatient rehabilitation.

LAY ABSTRACT

Patients discharged from stroke units who require rehabilitation may receive training provided in specialized facilities, clinics, or through home-based programmes. Here we investigated whether these different rehabilitation pathways could predict patients’ functional levels at 1 and 5 years post-stroke. We analysed data from 5,118 participants, and found that patients planned for home-based rehabilitation were more likely to survive and to manage daily activities, either independently or with assistance, compared with those without this kind of rehabilitation plan. In contrast, patients with planned inpatient rehabilitation were less likely to be alive or independent at follow-up. Our results suggest that different rehabilitation pathways have different effects on recovery. Notably, the patients referred to these different forms of rehabilitation also possess diverse characteristics, which must be considered when evaluating the effectiveness of each rehabilitation pathway, as patient characteristics also influence the observed outcomes.