Interaction between Caregiving Ability and Home Discharge Using Severity Classification upon Discharge

摘要

Background: The interaction between self-care and caregiving ability in home discharged stroke patients is unclear. Purpose: This study investigates the interaction between caregiving ability and individual self-care activities for post-stroke patients upon home discharge based on their motor-Functional Independence Measure (m-FIM) score. Methods: A total of 2626 stroke patients registered in the Japanese Rehabilitation Database were retrospectively analyzed. Extracted data were divided into three groups based on the m-FIM score at discharge and classified into two groups based on their discharge destination (home discharge, non-home discharge). After the data were modified as mean-centered values, a hierarchical multiple regression analysis evaluated the change in variance amount (ΔR2) using discharge destination as the dependent variable. Model 1 used two independent variables (Rankin Scale and cognitive FIM score), model 2 used two independent variables (caregiving ability and individual self-care), which were added to model 1, and model 3 used an interaction term value, which was added to model 2. Furthermore, a simple slope analysis was performed for these interaction effects. Results: The ΔR2 exhibited six and five self-care items in the moderate and mild groups, respectively. The interaction was significant on simple slope analysis in the moderate group for six self-care items (except dressing upper body, toileting, and bowel management) and in the mild group for three self-care items, including dressing upper body, bladder management, and climbing stairs). Conclusion: This study suggests the need for intervention, especially bladder management and single-foot standing ability during step climbing, in stroke patients discharged to home. In addition, caregiving ability is one of the factors that should be considered in mild group.