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- Title
PREDICTING INSTITUTIONALIZATION AFTER SUBACUTE STROKE REHABILITATION USING THE 12-ITEM WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE.
- Authors
TARVONEN-SCHRÖDER, SINIKKA; KOIVISTO, MARI
- Abstract
Objective: To evaluate the utility of the 12-item World Health Organization Disability Assessment Schedule (WHODAS-12) in predicting institutionalization after subacute stroke rehabilitation. Design: Prospective observational study. Methods: On a specialized rehabilitation ward, discharge WHODAS-12 scores of 156 consecutive patients (24-h National Institutes of Health Stroke Scale (NIHSS) ≥ 15) and assessment from their proxies were compared, and receiver operating characteristic curves for predicting institutionalization were generated. Clinician-rated assessments of functioning were applied for comparison. Results: Thirty-three percent of the patients were unfit to respond, due to the consequences of major stroke. However, both patient and proxy WHODAS- 12 sum scores differentiated the community (n = 70) and institution (n = 86) groups (p = 0.02 and p < 0.0001, respectively), the discriminative accuracy (area under the curve; AUC) being 0.63 and 0.79, respectively. In proxy assessments, the institutionalized patients were significantly more impaired in all item comparisons except for emotions and concentrating. Ability to participate differentiated the groups as accurately as activities (AUC 0.75 vs 0.78, respectively). The corresponding discriminative accuracy of the clinician-rated World Health Organization (WHO) minimal generic dataset sum score and modified Rankin Scale were 0.74 and 0.79 (p < 0.0001), respectively. Conclusion: Despite its brevity and subjectivity, the WHODAS-12 from proxies has shown high accuracy in predicting institutionalization after subacute rehabilitation of individuals with major stroke, the impact of participation being as relevant as that of activities.
- Subjects
SCIENTIFIC observation; ACADEMIC medical centers; NIH Stroke Scale; FISHER exact test; RISK assessment; SUBACUTE care; STROKE rehabilitation; HEALTH care teams; DESCRIPTIVE statistics; CHI-squared test; INSTITUTIONAL care; RECEIVER operating characteristic curves; SOCIODEMOGRAPHIC factors; DATA analysis software; LONGITUDINAL method; DISCHARGE planning
- Publication
Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation), 2023, Vol 55, p1
- ISSN
1650-1977
- Publication type
Article
- DOI
10.2340/jrm.v55.6531