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THE EFFECT OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING AND DEPRESSIVE SYMPTOMS ON DISCHARGE DESTINATION FOLLOWING STROKE REHABILITATION

Abdulaziz, Sahar S. (2017) THE EFFECT OF INSTRUMENTAL ACTIVITIES OF DAILY LIVING AND DEPRESSIVE SYMPTOMS ON DISCHARGE DESTINATION FOLLOWING STROKE REHABILITATION. Doctoral Dissertation, University of Pittsburgh.

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Abstract

Purpose: Accurate prediction of discharge destination following stroke rehabilitation is important in facilitating optimal services, guiding discharge planning and minimizing costs associated with stroke rehabilitation. Therefore, the aims of this dissertation were to evaluate the predictive validity of the Lawton Instrumental Activities of Daily Living scale in predicting discharge destination after stroke rehabilitation and determine if depressive symptoms measured at admission and changes in depressive symptoms during rehabilitation have an impact on discharge destination for patients admitted to inpatient rehabilitation facilities.
Subjects: Of 364 subjects, 210 (58%) had complete data on discharge destination and were eligible for study inclusion. Twenty-three subjects were excluded because they were discharged back to acute hospital settings. Analysis was based on 187 subjects.
Methods: Retrospective data obtained from charts of persons who had been admitted to rehabilitation between 2004 and 2010 were analyzed. Variables collected at admission included patients’ demographic data, clinical characteristics and functional status, including our variables of interest (the Lawton scale and depressive symptoms). Discharge destination was dichotomized as discharge to the community versus an institutional setting.
Results: Univariate analyses showed that patients with a better functional status on admission in both basic and instrumental activities of daily living (ADL) were less likely to be discharged to institutional settings and that patients with possible depressive symptoms on admission were more often discharged to an institutional setting rather than to the community. Moreover, discharge to an institutional setting was associated with a longer rehabilitation stay, increased stroke severity and higher cognitive impairment at admission. However, neither the impairment of IADL functioning nor the presence of depressive symptoms at admission were significant in the multivariate model. Only basic ADL functioning and stroke severity were significantly associated with a higher risk of institutionalization.
Conclusion: Instrumental ADL functioning as measured by the Lawton scale and depressive symptoms assessed on admission to rehabilitation were predictive of discharge from rehabilitation to an institutional setting, but not after accounting for basic ADL functioning.


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Details

Item Type: University of Pittsburgh ETD
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Abdulaziz, Sahar S.ssa24@pitt.edussa24
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairWhitney, Susan L.whitney@pitt.edu
Committee MemberLandgraff, Nancy C.nlandgraff@ysu.edu
Committee MemberMarchetti, Gregory F.marchetti@duq.edu
Committee MemberSkidmore, Elizabeth R.skidmore@pitt.edu
Committee MemberSparto, Patrick J.psparto@pitt.edu
Date: 11 September 2017
Date Type: Publication
Defense Date: 14 August 2017
Approval Date: 11 September 2017
Submission Date: 3 August 2017
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 175
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Discharge destination, stroke rehabilitation
Date Deposited: 11 Sep 2017 15:12
Last Modified: 11 Sep 2017 15:12
URI: http://d-scholarship.pitt.edu/id/eprint/32973

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