Abstract
Background: Stroke rehabilitation - both inpatient and community - is an important part of current post-stroke care, aimed at improving outcomes. However, there is a lack of recent New Zealand research exploring associations between rehabilitation and health-related quality of life (HRQoL) post stroke.
Aim: To explore associations between stroke rehabilitation and HRQoL.
Design: Secondary analysis of data from a prospective, observational study.
Setting: Twenty-eight New Zealand hospitals.
Population: Overall, 2379 patients with stroke.
Methods: Data was collected from consecutive patients with stroke who were admitted to New Zealand hospitals between 1st May and 31st July 2018. Further data collection occurred until the target sample size was reached, or until 31st October 2018, whichever occurred first. Patients were contacted for routine follow-up at three months and were invited to consent to follow-up at six and 12 months. We used the EQ-5D-3L and calculated the health utility score using weightings for the New Zealand population. We used linear regression to explore correlations between rehabilitation and HRQOL, adjusting for known confounders including stroke severity.
Results: There were 750/2379 (31.5%) patients who received inpatient rehabilitation and 838/2379 (35.2%) who received community rehabilitation. In a multivariate analysis, patients who received inpatient rehabilitation, compared to people who did not, had lower HRQoL scores at both three months (-0.07, 95% CI -0.10 to -0.04) and 12 months (-0.08, 95% CI -0.12 to -0.04). Patients who received community rehabilitation had higher HRQoL scores at 12 months (0.04, 95% CI 0.002 to 0.08)). Stratifying scores by stroke severity, we found results in favor of inpatient rehabilitation for only the most severely impaired patients and for community rehabilitation for all but the least impaired.
Conclusions: We found a negative correlation between HRQoL and inpatient rehabilitation, and a positive association between HRQoL and community rehabilitation. A combination of personal, environmental and service factors may explain this result. Future research directly comparing outcomes for patients receiving comprehensive community-based and inpatient rehabilitation, would be useful to support stroke rehabilitation service development.
Clinical rehabilitation impact: Individualized rehabilitation planning should consider social supports, the home environment, functional level and patient preference to support decision-making around rehabilitation location and optimize outcomes.