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Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study.

OBJECTIVE
to identify important demographic, clinical and functional determinants of successful discharge of geriatric patients from skilled nursing facilities (SNFs), particularly the role of multi-morbidity.


DESIGN
prospective cohort study with data collection at baseline and at discharge.


SETTING
fifteen SNFs in the Netherlands.


PARTICIPANTS
of 378 eligible patients, 186 were included.


METHODS
multi-disciplinary teams recorded demographic and disease characteristics, as well as functional status, cognitive functioning and multi-morbidity on admission. The study outcomes were discharge to an independent living situation within 1 year of admission and functional status at discharge (Barthel index).


RESULTS
of the included 186 patients, 175 were followed up. Of these patients, 123 (70%) were successfully discharged. High Berg Balance Scale (BBS) and Star Cancellation test (SCT) scores independently contributed to 48% of the variance of functional status at discharge, while low age, high BBS and SCT scores were independently related to successful discharge, explaining 33% of the variance. Multi-morbidity was not an independent determinant of rehabilitation outcome.


CONCLUSION
geriatric patients admitted for 'low intensity' rehabilitation in SNFs after stroke appeared to have a fair prognosis for being successfully discharged. Postural control was an important determinant of both outcome measures.