2026 American Academy of Neurology Abstract Website

Objective:

To examine predictors associated with discharge destinations following inpatient-rehabilitation-(IR) in a national cohort of patients with stroke in the United States.

Background:

Predictors of discharge to home/community from inpatient-rehabilitation remain controversial in patients with stroke.

Design/Methods:

Retrospective-observational-cohort-study of 141,712 patients with stroke admitted to IR 1/1/2015-9/30/2019, comparing discharge destinations (community/home, skilled-nursing-facility-[SNF] or return-to-acute-care) by demographic (Age, gender), and Functional-Independence-Measure-[FIM] discharge and FIM gain score changes.

Results:

75% (n=107,342) of stroke patients were discharged to home/community, mean-age=69; average-LOS=15.2-days, average-total-FIM-gain=41; 13% (n=18,825) were discharged to SNFs, mean-age=73, average-LOS=20.6-days, total-FIM-gain=26.5; 11% (n=15,545) were discharged back-to-acute-care hospitals, mean-age=70, LOS=8.9-days, total-FIM-gain=13.6. Community-discharge was associated with younger-age (p<.001;F=394), greater total-FIM-gain-mean of (F=12,359;p <.001), and intermediate length of stay LOS-of-15.2-days (F=122.8;p<.001). Adjusting for length-of-stay the greatest FIM-gain-per-LOS (FIM Efficiency) was for those discharged to the community 3.1-FIM-points-gain/day compared to 1.4 for SNF and 1.75 for acute-care (F=5,145;p<.001). Discharge to community was also associated with greater FIM-discharge scores for: bed-transfers (F=15,363;p<.001), walking (F=14701;p<.001), bladder-control (F=8048;p<.001), memory (F=5115; p<.001), Social (F =5692; p< .001), Comprehension (F=5840; p <.001), Expression (F=5361; p<.001) and Problem Solving (F=5722; p<.001). Multinomial logistic regression for prediction of community discharge using FIM Discharge scores (bed transfer, walking, bladder, and all cognitive measures) as predictors was significant and explained 42% (R²=.42) of the variance (Chi-Square=56745;p<.001) with bed transfer gain being the strongest predictor (Chi-Square 4898;P<.001). Finally, canonical discriminant-function-analysis to test model-validity FIM discharge scores correctly classified correctly classified 94% of the sample (Chi-Square 64081; P <.001) with an Eigenvalue of .52 and canonical correlation of .59. 73.7% of the sample (Chi-Square 10634.9; P <.001) with an Eigenvalue of .63 and canonical correlation of .62.

Conclusions:

Most patients were discharged to home/community. Discharge FIMS for bed transfers was the most important predictor followed by walking, and bladder control. Cognitive measures were less significant as predictors for community discharge.