Comparative Analysis of Functional Outcomes in Stroke Patients: First Admission Versus Readmission to Inpatient Rehabilitation

Objectives: To explore potential differences in functional outcomes of stroke patients undergoing inpatient rehabilitation between their first admission and readmission to the rehabilitation ward. Study design: Observational study design: retrospective chart review Setting: A tertiary care hospital, Thailand. The inpatient ward (25 beds) of the Department of Rehabilitation Medicine, which has a limited admission period of up to 3 weeks. Participant: Stroke patients over 18 years of age who were admitted between January 1, 2015, and December 31, 2020. Methods: Using matched demographics, a comparison of functional outcomes between the first admission and readmission of stroke patients were conducted. Functional outcomes were evaluated based on changes in the Modified Barthel Index (MBI), rehabilitation efficiency (average increase in MBI scores per day), and rehabilitation effectiveness (potential improvement) comparing patients after their first admission and those following readmission. Results: The demographic characteristics of patients at their first admission and readmitted patients showed no significant differences in age, sex, underlying disease, stroke classification, hemineglect, aphasia, dysphagia, motor power of the upper extremities, onset-to-admission interval, length of stay, or admission MBI score (p > 0.05). Functional outcomes were calculated and are presented as follows: The median of MBI changes were 2 (1, 5) for the first admission and 2 (1, 4) at readmission, with r = 0.09, p = 0.19; rehabilitation efficiency was 11 (6, 27) for the first admission and 10 (3, 18) at readmission, with r = 0.14, p = 0.05; and rehabilitation effectiveness was 25 (9, 50) for the first admission and 20 (5, 37) at readmission, with r = 0.12, p = 0.10. Conclusions: The improvement in functional outcomes of stroke patients upon readmission to the rehabilitation ward showed no statistically significant difference compared to the improvement during their first admission when the length of stay was limited to 3 weeks. This suggests that in hospitals with a short length of stay, readmitting patients for further rehabilitation may be warranted. However, the results may not generalize to settings with a longer average length of stay. A study investigating the prognostic factors for functional outcome improvement in readmitted stroke patients is warranted.