‘Home time’ is a useful measure of stroke impact on functional status


By Michael Woodhead

5 Feb 2020

‘Home time’ may be used as a simple and robust measure of the adverse impact of stroke on patients’ functional status, Australian researchers say.

The number of days spent living at home at 90 days after stroke (‘home‐time’) is a patient‐centred outcome that can be conveniently and objectively ascertained from administrative data, according to a study carried out by researchers at the Department of Neurology at Sydney’s, Royal Prince Alfred Hospital.

In a review of outcomes for 74,501 stroke patients in NSW between 2005 and 2014 found that the ‘home-time’ was was reduced with increasing age, more severe disease and after intracerebral and subarachnoid haemorrhage.

Less functional independence and greater comorbidity burden also reduced time spent at home in the 90 days following a stroke.

‘Home‐time’ was calculated based on healthcare  service and compared with Glasgow Coma Scale (GCS) scores on initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission.

The researchers found that the median time spent at home after any stroke was 53 days at 90 days after the event. The ‘home‐time’ was longer (60 days) after ischaemic stroke, shorter (49 days) after subarachnoid haemorrhage and the lowest rate (0 days) was after intracerebral haemorrhage.

Overall, almost 20% of patients spent no days at home in the 90-days after stroke, including 30.3% of ischaemic stroke patients, 55.2% of patients with intracerebral haemorrhage and 38.6%  with subarachnoid haemorrhage.

For patients who survived their stroke admission, the median ‘home-time’ was similar for patients with ischaemic stroke and subarachnoid haemorrhage (70 vs 69 days)  and lower for those with an intracerebral haemorrhage (55 days)

The study also showed that GCS and FIM scores correlated strongly with ‘home‐time’ , which was reduced more in females compared with males after stroke.

The researchers said their findings validated ‘home time’ as a robust, inexpensive, replicable and valid patient-centred outcome that facilitates population-based stroke surveillance.

“These findings underscore the immediate adverse impact of stroke on people’s ability to live at home after the event and provide further evidence that ‘home-time’ serves as a useful proxy for disability,” they concluded.

The findings are published in the International Journal of Clinical Practice.

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