Adherence to Clinical Guidelines Improves Patient Outcomes in Australian Audit of Stroke Rehabilitation Practice

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 6; pp. 965 - 971
• Main Authors: Hubbard, Isobel J., MOT, Harris, Dawn, Kilkenny, Monique F., MPH, Faux, Steven G., MBBS, FRACGP, FAFRM, Pollack, Michael R., MBBS, FAFRM, FACRM, FFPM, MMedSci, Cadilhac, Dominique A., MPH, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Australia; Biological and medical sciences; Delivery of health care; Diseases of the osteoarticular system; Female; Guideline Adherence; Humans; Inpatients - statistics & numerical data; Male; Medical Audit; Medical sciences; Middle Aged; Miscellaneous; Neurology; Outcome Assessment (Health Care); Pain Measurement; Physical Medicine and Rehabilitation; Physical Therapy Modalities - standards; Practice Guidelines as Topic - standards; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recovery of Function; Rehabilitation; Rehabilitation Centers - standards; Stroke; Stroke - diagnosis; Stroke Rehabilitation; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Stroke; Delivery of health care; Rehabilitation; Human; Nervous system diseases; Prognosis; Cardiovascular disease; Care; Cerebral disorder; Vascular disease; Audit; Reeducation; Orthopedics; Central nervous system disease; Cerebrovascular disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2012.01.011

Abstract Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Objective To study the correlation between adherence to recommended management and good recovery outcomes in an Australian cohort of inpatients receiving rehabilitation. Design Processes of care were audited and included those recommended in the Australian Clinical Guidelines for Stroke Rehabilitation and Recovery. Setting National audit data from 68 rehabilitation units were used, with each hospital contributing up to 40 consecutive cases. Participants Not applicable. Interventions Not applicable. Main Outcome Measures Discharged home or an increase of greater than or equal to 22 in FIM scores between admission and discharge. Multivariable logistic regression models controlling for patient clustering were used to assess the associations between adherence to recommended management and recovery outcomes (dependent variables). Results Hospitals contributed 2119 patients (median age 75y, 53% men). We found that rehabilitation units providing evidence-based management (eg, treatment for sensorimotor impairment 38%, hypertonicity 56%, mobility 94%, and home assessments 71%) were more likely to provide better recovery outcomes for people with stroke. A discharge FIM score of 100 was clinically relevant and was strongly correlated with whether or not a patient was discharged home. We found very good correlation between admission and discharge FIM scores in stroke rehabilitation. Conclusions This is one of the first study comparing adherence to recommended management in Australian rehabilitation units and stroke recovery outcomes based on national audit data. Novel findings include the significance of an FIM score between 80 and 100 and the clinical significance of various management processes.