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Title: Trade-offs between effectiveness and efficiency in stroke rehabilitation
Authors: Koh, G.C.-H. 
Chen, C.
Cheong, A.
Choo, T.B. 
Pui, C.K. 
Phoon, F.N.
Ming, C.K.
Yeow, T.B.
Petrella, R.
Thind, A.
Koh, D. 
Seng, C.K. 
Keywords: Activities of daily living
Issue Date: Dec-2012
Citation: Koh, G.C.-H., Chen, C., Cheong, A., Choo, T.B., Pui, C.K., Phoon, F.N., Ming, C.K., Yeow, T.B., Petrella, R., Thind, A., Koh, D., Seng, C.K. (2012-12). Trade-offs between effectiveness and efficiency in stroke rehabilitation. International Journal of Stroke 7 (8) : 606-614. ScholarBank@NUS Repository.
Abstract: Background Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation. Aims To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency. Methods Using a retrospective cohort study design, we studied all stroke patients (n=2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period. Results Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β -4·7 (95% confidence interval -7·4 to -2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2-4·0) in effectiveness but a decrease of 0·04 (95% confidence interval -0·05 to -0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7-10·3) in effectiveness but a decrease of 0·82 (95% confidence interval -0·90 to -0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30-62 and length of stay was 37-41 days. Conclusions: There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.
Source Title: International Journal of Stroke
ISSN: 17474930
DOI: 10.1111/j.1747-4949.2011.00612.x
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