Predicting Recovery After Stroke

Reference: Stinear CM, Smith M-C, Byblow WD (2019) Prediction tools for stroke rehabilitation, Stroke 50(11), 3314-3322 DOI: 10.1161/STROKEAHA.119.025696

First Paragraph: Clinicians rate the patient’s prognosis for functional recovery as the most important factor when considering discharge destination from the acute setting. The prognosis and discharge destination are typically based on clinical impression, incorporating clinical and demographic factors such as stroke severity and age. However, clinicians cannot know whether the prognoses they make at the acute stage are correct if they do not routinely assess each of their patients several months later. Furthermore, this gestalt approach can produce differing opinions about prognosis and these seem to produce variation in discharge planning. Data from >31 000 stroke patients discharged from >900 acute hospitals in the United States revealed a 3-fold variation in the rates of discharge to inpatient rehabilitation and skilled nursing facilities, even when casemix and the availability of these facilities were accounted for. Together, these studies indicate that clinicians’ prognoses are an important source of variation and may contribute to inequitable access to rehabilitation services. Both studies identify the need for standardized tools to support less variable and more equitable decision-making……