For stroke patients, rating scales predict discharge destination

Note:  I will take off the remainder of the year and begin again in January.  Happy Holidays!!!


Stroke survivors with higher scores on widely used outcome measures are more likely to be discharged home from the hospital, while those with lower scores are more likely to go to a rehabilitation or nursing care facility, reports a paper in the January issue of The Journal of Neurologic Physical Therapy (JNPT). The journal is published by Wolters Kluwer.

Standardized rating scales can help to support decisions about discharge destination for stroke patients leaving the hospital, according to the analysis by Dr. Emily Thorpe, PT, DPT, and colleagues of Walsh University, North Canton, Ohio, under the mentorship of Dr. Robert S. Phillips, PT, DPT, PhD, NCS. “These results provide a framework with which to start the plan of care and discharge process in acute and sub-acute settings,” the researchers write.

Outcome Measure Scores to Predict Stroke Discharge – Pooled Evidence Analysis

In a systematic research review, Dr. Thorpe and colleagues identified nine previous studies of the relationship between standardized outcome measures and discharge destination in patients with stroke. Five studies–including more than 6,000 patients–provided evidence suitable for analysis of pooled data, called meta-analysis.

Meta-analyses assessed the predictive value of two outcome measures. Four studies evaluated the Functional Independence Measure (FIM), which assesses the level of assistance needed to perform daily tasks. The FIM is commonly used in hospitalized patients with a wide range of conditions. Two studies used the National Institutes of Health Stroke Scale (NIHSS), which is specifically designed to assess stroke severity and resulting disability. (One of the studies included both measures.)

Both rating scales were good indicators of the discharge destination for stroke patients, according to the meta-analyses. For each one-point improvement in the FIM score (on a scale from 18 to 126), patients were about eight percent more likely to be sent home from the hospital, rather than to a rehabilitation or nursing facility.

On both the FIM and NIHSS, patients who scored in the “above average” range were 12 times more likely to be discharged to home. In contrast, patients with “average” scores were 1.9 times more likely to be discharged to a care facility.

Patients with “poor” scores on the FIM and NIHSS were 3.4 times more likely to be discharged to an institution. For this group, the discharge destination was more likely to be a skilled nursing facility, rather than to an inpatient rehabilitation center.

Interdisciplinary rehabilitation services are crucial to help stroke patients toward regaining their functional ability and lifestyle. With the aging population and increased spending for stroke management, it’s more important than ever to provide efficient care for patients recovering from a stroke. About 20 percent of stroke survivors require institutionalized care beyond three months; many patients need continued assistance after they return home.

Outcome measures such as the FIM and NIHSS are widely used to assess the functional abilities or clinical condition of stroke patients. However, it has been unclear how scores on these rating scales are related to discharge destination.

The new analysis provides evidence-based data to support critical decision-making about discharge destination in stroke patients. “Findings from these meta-analyses are consistent with common sense practice: the better a patient’s outcome measure score, the greater the likelihood of home discharge,” Dr. Thorpe and coauthors write. The results show the “quantitative impact” of outcome measure scores on discharge decisions.

The researchers emphasize that rating scales such as the FIM and NIHSS are just one factor to consider in determining the best discharge destination for each individual patient after a stroke. Dr. Thorpe and colleagues conclude: “Ultimately, standardized outcome measures should be further used and studied among the post-stroke population to improve healthcare policy and compliment clinical judgment in the task of recommending discharge destinations for patients to receive the necessary care for achieving their optimal function.”


Click here to read “Outcome Measure Scores Predict Discharge Destination in Patients With Acute and Subacute Stroke: A Systematic Review and Series of Meta-analyses.”

I am proud….


I will tell you why I am proud…in a minute!

But first, I just did a speaking engagement for the Stroke Victims Survivors in Beaverton on Saturday. Jill and I were touched by the wonderful people we meet.  This is one of the few meetings where EVERYONE had experienced what I am experiencing.  There was not “you can imaging xxxx” or “imagine what you would do if xxxx happened”? They all got it…and they didn’t have to imagine.

I was proud and blessed to be in front of that special group.  As we are told, “every stroke is different” and that was true here.  Carrie thanked me, but I actually thank YOU. By seeing what each of you is dealing with,  MAKES ME want to tell others and share OUR experience.

And special birthday wish to Charlie Brown, who is celebrating his 80th birthday in September!  God bless you and all of the wonderful things in your life. Keep up your activity of meeting with stroke victims and letting them know that you are one of them.

And here is why I am proud:


Quick…get a flu shot!


Posted by Lucy Lazarony

A new study from the University of Lincoln in England shows the risk of suffering a stroke is greatly reduced for up two months after receiving a flu shot.

The study published in the journal Vaccine shows the risk of a first stroke is reduced by one-fifth in the first 59 days after taking the flu vaccine.

Flu Shots Reduce Stroke

Following a flu shot, there were:
• 36 percent fewer stroke cases in the first week
• 30 percent fewer stroke cases in the second week
• 24 percent fewer stroke cases in the third and fourth week

The study also found a 17 percent drop in stroke cases in days 29 to 59 after patients received a flu vaccine.

The biggest drop in stroke risk came in the first three days, when there was a 55 percent drop in stroke cases after patients received a flu shot.

The study looked at how the flu vaccine affected stroke risk in almost 18,000 patients, aged 18 and older.

Each patient in the study had suffered a first stroke between 2001 and 2009. And just over half of the patients in the study were women.  All the patients received flu vaccines.

Researchers looked at how many strokes occurred within 180 days for patients receiving flu shots.

According to researchers, the earlier the vaccine was administered during flu season, the greater the protection for the patient against a first stroke. And patients that received the flu vaccine between Sept. 1 and Nov. 15, at the start of flu season, saw the greatest reduction in risk for strokes.
The findings support flu shots for people with high risk of stroke and encourage early vaccinations during flu season.

The specific study method used by researchers, a self-controlled case study, reduced the chances that the lowered stroke risk findings were caused by any other reason than the flu vaccinations that each patient received.

Researchers are looking to confirm the research findings in clinical studies.

Future studies may also determine how much a flu vaccine would lower stroke risk in younger adults.

Earlier studies have already linked flu vaccinations with a reduced risk of a heart attack as well as a first stroke.

Each year flu vaccinations are given to protect against the influenza virus and prevent respiratory complications such as pneumonia.  Flu vaccines have a maximum effectiveness of six months.

Jill is helping out; OHSU takes a different approach to designing new South Waterfront building…

A warehouse along Macadam Avenue in Portland houses a maze of cardboard, almost like an adult version of children’s forts.

The cardboard has aided Oregon Health & Science University in designing the rooms inside its planned $340 million patient building, parking structure and guest house that will break ground early next year.

In an unusual move, OHSU and ZGF Architects are engaging all the various groups who will use the building in the planning process. Doctors, nurses, patients, engineers and housekeepers all have given input over the past five months.

“It’s given everyone a new perspective on how we can craft everything,” said Dr. Reid Mueller, associate professor in the Division of Facial Plastic and Reconstructive Surgery. “Everything from the way the hallway flows to the positioning of the chair when you’re sitting with your family member and the importance of privacy in the recovery area.”

One patient who has participated is Jill Viggiano, whose husband had a stroke seven years ago.

“I have no medical background at all, it’s like stepping into Oz,” Viggiano said. She suggested the waiting room in the new building contain more distractions for family members, including kids — “something to play with and look at and be a kid and not feel like they’re annoying everyone else.”

The Center for Health and Healing South, as the new building will be called, will sit just south of the existing Center for Health and Healing, which contains doctors’ offices and outpatient space. It will also be a little shorter, at 15 as opposed to 16 floors.

The entire project will encompass 750,000 square feet. It will include 48 “extended stay” rooms and 76 guest rooms above the adjacent five-story garage. A small park will remain next to the patient building.

CHH-South will also contain space for surgery, interventional procedures, outpatient clinics for cancer, cardiovascular disease and gastroenterology, a pharmacy and imaging and lab space, conference center, parking garage and space for Knight Cancer Institute clinical trials.

An oval-shaped “mission control design” will allow gastroenterology, cardiology and pulmonary procedures to share a central core and some nursing staff.

“One of the great things about the space is that we’re integrating with other specialties,” said Dr. Gene Bakis, assistant professor of medicine, Division of Gastroenterology and Hepatology. “Patients are best served by multiple specialties. Here we’re going to be feet away from each other to promote cooperation and collaborative thinking.”

Jill continues to be my hero!

We spoke at a Professional Development Day at a local hospital.  Here are some of the comments:

It helped me remember why I became a nurse.

Thank you for bringing the speakers Jill and Gordon—Painful Blessings.

Please tell the Viggiano’s thank you for sharing their story.  Really puts everything in perspective.  I so admire both Jill and Gordon.  I honestly would not be able to do what they have done.  I’m on a redeye flight tonight, so their book will be a good read! So inspiring!

The Painful Blessing was an amazingly inspirational motivating share.

I liked the slides that were presented with the talk.

I like the patient perspective.


Great Q & A.


Why is he still speaking at hospitals?


Yes…I get such a thrill speaking to doctors, nurses, administrators, and therapists…probably, because I have exceeded what they projected what I would get back.  And I LIKE that.

I LIKE being back infront of the people who really don’t know what happens after a patient leaves the hospital.  I gets a sense of satisfaction of knowing what they say could have a real outcome for a patient.  But, so few patients actually come back to the hospital!  Some that don’t come back are just glad to be out of the hospital.  Some are probably just scraping by to make ends meet. Then there are the ones like me: 7 years….  they still have disabilities and they don’t want to come back because they are different.  NONE (well they say none) of these patients come back.  I would like to do something about that!  Stay tuned while I think about what that something is.

My 7 year anniversary is this month. I must say, I feel great.  You will get a different answer from my wife!  You see, her left brain works just fine!