Introduction:
Early physical therapy (PT) consults and subsequent rehabilitation services have been shown to improve functional and mobility outcomes post stroke. Shortage of PT staff may impact how soon patients can be seen after a physician’s order (PO) and rehabilitation outcomes. The current preliminary study purposed to assess the effects of time elapsed between PO for PT services and the first PT consult ≤ or >48 hours (time to PT order = TPO), on patient’s length of stay (LOS) and scores on the NIH Stroke Scale (NIHSS) at discharge, in a busy acute stroke unit of a regional health care facility. It was hypothesized that TPO of ≤48 hours after initial PO for PT services will show better LOS and NIHSS scores (at discharge) outcomes compared to TPO >48 hours.
Methods:
A total of 291 stroke patients who presented at an acute hospital were retrospectively placed in either a TPO ≤ 48 hours group, G1 (n=147), or a TPO >48 hours group, G2 (n=144) based on the time of their first PT consult after a PO. The LOS and NIHSS data were subjected to statistical analysis.
Results:
There were no significant differences in LOS (G1=5.5 ± 4.61
vs.
G2= 5.9 ± 5.62 days;
p=0.6542
) and discharge NIHSS scores (
p=0.6728
) of either groups. A
post hoc
regression analysis to examine impact of factors such as demographics (age, gender, weight, etc), number of PT visits (PTV) and discharge destination (DD) revealed that TPO (
p<0.0001
), PTV (p<0.0001) and DD (p<0.0001) were significant contributors to observations in group G1; while PTV (
p<0.0001
) and DD (
p<0.0001
) were the only significant contributors to observations in the G2 group, TPO was not significant (
p=0.0646
).
Conclusions:
Ideally, stroke patients should be evaluated for physical therapy services within 24 hours of a PO. Shortage of PT staff in a busy health care facility may impact how soon patients can be seen. Although the current pilot study did not reveal significant changes in LOS, and NIHSS scores of stroke patients at discharge irrespective of whether patients were seen by physical therapists ≤ or >48 hours after a PO, severity of the stroke, previous history of stroke or TIAs, and other co-morbidities that could have confounded the results were not examined. Future study design will take into account these potential confounding variables and other outcome measures.
Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study