Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients.
<h4>Background</h4>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 outcome...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0286296 |
| _version_ | 1797792626501484544 |
|---|---|
| author | David S Kushner Doug Johnson-Greene Elizabeth R Felix Cheryl Miller Maite K Cordero Stacy A Thomashaw |
| author_facet | David S Kushner Doug Johnson-Greene Elizabeth R Felix Cheryl Miller Maite K Cordero Stacy A Thomashaw |
| author_sort | David S Kushner |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Objectives</h4>To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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. |
| first_indexed | 2024-03-13T02:35:40Z |
| format | Article |
| id | doaj.art-c9bf232b02c94a02849d8886dad9acb4 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-13T02:35:40Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-c9bf232b02c94a02849d8886dad9acb42023-06-29T05:31:20ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01185e028629610.1371/journal.pone.0286296Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients.David S KushnerDoug Johnson-GreeneElizabeth R FelixCheryl MillerMaite K CorderoStacy A Thomashaw<h4>Background</h4>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.<h4>Objectives</h4>To analyze IR efficacy, and possible predictors of discharge to home/community in a US-national-sample of GBS patients.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0286296 |
| spellingShingle | David S Kushner Doug Johnson-Greene Elizabeth R Felix Cheryl Miller Maite K Cordero Stacy A Thomashaw Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. PLoS ONE |
| title | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. |
| title_full | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. |
| title_fullStr | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. |
| title_full_unstemmed | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. |
| title_short | Predictors of discharge to home/community following inpatient-rehabilitation in a US national sample of Guillain-Barre-Syndrome patients. |
| title_sort | predictors of discharge to home community following inpatient rehabilitation in a us national sample of guillain barre syndrome patients |
| url | https://doi.org/10.1371/journal.pone.0286296 |
| work_keys_str_mv | AT davidskushner predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients AT dougjohnsongreene predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients AT elizabethrfelix predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients AT cherylmiller predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients AT maitekcordero predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients AT stacyathomashaw predictorsofdischargetohomecommunityfollowinginpatientrehabilitationinausnationalsampleofguillainbarresyndromepatients |