Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients
Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge...
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| Veröffentlicht in: | PloS one 2023-05, Vol.18 (5), p.e0286296-e0286296 |
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| creator | Kushner, David S Johnson-Greene, Doug Felix, Elizabeth R Miller, Cheryl Cordero, Maite K Thomashaw, Stacy A |
| description | Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study.
To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.
Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination.
81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001).
Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination. |
| doi_str_mv | 10.1371/journal.pone.0286296 |
| format | Article |
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To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.
Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination.
81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001).
Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0286296</identifier><identifier>PMID: 37228065</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Activities of daily living ; Age ; Analysis ; Biology and life sciences ; Care and treatment ; Cohort Studies ; Demographic variables ; Effectiveness ; Eigenvalues ; Engineering and Technology ; Evaluation ; Gender ; Guillain-Barre syndrome ; Guillain-Barre Syndrome - rehabilitation ; Hospital systems ; Hospitals ; Humans ; Inpatients ; Intensive care ; Length of Stay ; Medicaid ; Medical prognosis ; Medical research ; Medical screening ; Medicare ; Medicine and health sciences ; Medicine, Experimental ; Nursing ; Paralysis ; Patient Discharge ; Patient outcomes ; Patients ; People and places ; Physical Sciences ; Polyneuropathy ; Population studies ; Quality of life ; Recovery of Function ; Rehabilitation ; Rehabilitation Centers ; Research and Analysis Methods ; Retrospective Studies ; Self-care, Health ; Treatment Outcome ; United States ; Variables ; Variance analysis ; Ventilators ; Wheelchairs</subject><ispartof>PloS one, 2023-05, Vol.18 (5), p.e0286296-e0286296</ispartof><rights>Copyright: © 2023 Kushner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Kushner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Kushner et al 2023 Kushner et al</rights><rights>2023 Kushner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c642t-10299942161a3296e4999f868d2463be17640fd5babf3339c6a60f2db2837b833</cites><orcidid>0000-0001-6090-6304</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212147/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212147/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37228065$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Tekleab, Atnafu Mekonnen</contributor><creatorcontrib>Kushner, David S</creatorcontrib><creatorcontrib>Johnson-Greene, Doug</creatorcontrib><creatorcontrib>Felix, Elizabeth R</creatorcontrib><creatorcontrib>Miller, Cheryl</creatorcontrib><creatorcontrib>Cordero, Maite K</creatorcontrib><creatorcontrib>Thomashaw, Stacy A</creatorcontrib><title>Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study.
To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.
Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination.
81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001).
Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.]]></description><subject>Activities of daily living</subject><subject>Age</subject><subject>Analysis</subject><subject>Biology and life sciences</subject><subject>Care and treatment</subject><subject>Cohort Studies</subject><subject>Demographic variables</subject><subject>Effectiveness</subject><subject>Eigenvalues</subject><subject>Engineering and Technology</subject><subject>Evaluation</subject><subject>Gender</subject><subject>Guillain-Barre syndrome</subject><subject>Guillain-Barre Syndrome - rehabilitation</subject><subject>Hospital systems</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Intensive care</subject><subject>Length of Stay</subject><subject>Medicaid</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medical 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rehabilitation</topic><topic>Hospital systems</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Intensive care</topic><topic>Length of Stay</topic><topic>Medicaid</topic><topic>Medical prognosis</topic><topic>Medical research</topic><topic>Medical screening</topic><topic>Medicare</topic><topic>Medicine and health sciences</topic><topic>Medicine, Experimental</topic><topic>Nursing</topic><topic>Paralysis</topic><topic>Patient Discharge</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>People and places</topic><topic>Physical Sciences</topic><topic>Polyneuropathy</topic><topic>Population studies</topic><topic>Quality of life</topic><topic>Recovery of Function</topic><topic>Rehabilitation</topic><topic>Rehabilitation Centers</topic><topic>Research and Analysis Methods</topic><topic>Retrospective Studies</topic><topic>Self-care, Health</topic><topic>Treatment Outcome</topic><topic>United 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Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kushner, David S</au><au>Johnson-Greene, Doug</au><au>Felix, Elizabeth R</au><au>Miller, Cheryl</au><au>Cordero, Maite K</au><au>Thomashaw, Stacy A</au><au>Tekleab, Atnafu Mekonnen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-05-25</date><risdate>2023</risdate><volume>18</volume><issue>5</issue><spage>e0286296</spage><epage>e0286296</epage><pages>e0286296-e0286296</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[Guillain-Barre-Syndrome (GBS), an autoimmune polyneuropathy causing acute flaccid paralysis, is a rare condition with1-2 cases per 100,000 annually (approximately 5000 cases/year) in the United States (US). There is a paucity of published data regarding patient outcomes in association with discharge destinations following inpatient-rehabilitation (IR) in this patient population, thus this study.
To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.
Retrospective-observational-cohort study of 1304 GBS patients admitted to IR comparing discharge disposition destinations (community/home, skilled-nursing-facility [SNF], or return to acute-care) by demographic (age, gender) and clinical variables (length-of-stay [LOS], case-mix-index [CMI], and Functional-Independence-Measure [FIM] score changes). Multinomial-logistic-regression and discriminant-function-analysis were performed to determine model fit in predicting discharge destination.
81.8% were discharged to home/community- average LOS 19-days, total-FIM-gain 43.2; 9.8% discharged to SNFs- average LOS 27.5-days, total-FIM-gain 27.2; and 8.4% discharged to acute-care- average LOS 15.4-days and total-FIM-gain 16.5, (F = 176, p < .001). Stepwise-linear-regression for prediction of community discharge showed change in FIM-Bed/chair/wheelchair-Transfers was the most significant predictor (Wald = 42.2; p < .001), followed by CMI (Wald = 26.9; p < .001), change in FIM-walking/wheelchair (Wald = 14.9; p < .001), and age (Wald = 9.5; p < .002). Using discriminant-function-analysis to test model validity for predicting discharge disposition, FIM-change for Bed/chair/wheelchair Transfers, Walking, and Self-Care as predictors resulted in a classification rate of 78.1%, 92% of variance explained, and Eigenvalue of .53 (p < .001).
Total-FIM scores improved in all groups, and most patients were discharged to home/community suggesting IR efficacy. The ability to transfer bed/chair/wheelchair was the most important predictive factor associated with discharge destination.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37228065</pmid><doi>10.1371/journal.pone.0286296</doi><tpages>e0286296</tpages><orcidid>https://orcid.org/0000-0001-6090-6304</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-05, Vol.18 (5), p.e0286296-e0286296 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2819261568 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Activities of daily living Age Analysis Biology and life sciences Care and treatment Cohort Studies Demographic variables Effectiveness Eigenvalues Engineering and Technology Evaluation Gender Guillain-Barre syndrome Guillain-Barre Syndrome - rehabilitation Hospital systems Hospitals Humans Inpatients Intensive care Length of Stay Medicaid Medical prognosis Medical research Medical screening Medicare Medicine and health sciences Medicine, Experimental Nursing Paralysis Patient Discharge Patient outcomes Patients People and places Physical Sciences Polyneuropathy Population studies Quality of life Recovery of Function Rehabilitation Rehabilitation Centers Research and Analysis Methods Retrospective Studies Self-care, Health Treatment Outcome United States Variables Variance analysis Ventilators Wheelchairs |
| title | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T04%3A43%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predictors%20of%20discharge%20to%20home/community%20following%20inpatient-rehabilitation%20in%20a%20US%20national%20sample%20of%20Guillain-Barre-Syndrome%20patients&rft.jtitle=PloS%20one&rft.au=Kushner,%20David%20S&rft.date=2023-05-25&rft.volume=18&rft.issue=5&rft.spage=e0286296&rft.epage=e0286296&rft.pages=e0286296-e0286296&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0286296&rft_dat=%3Cgale_plos_%3EA750653734%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2819261568&rft_id=info:pmid/37228065&rft_galeid=A750653734&rft_doaj_id=oai_doaj_org_article_1e69e336c0534129bd45bf3e79a7aab8&rfr_iscdi=true |