Date Presented 04/03/2025
This study suggests that socially vulnerable stroke survivors may be less likely to discharge to acute rehabilitation units despite the predictive value of the Activity Measure for Post-Acute Care ‘6-Clicks’ to determine postacute discharge settings.
Primary Author and Speaker: Hanna Popoviciu
Contributing Authors: Dawn Kurakazu
PURPOSE: Activity Measure for Post-Acute Care (AMPAC) 6-Clicks predicts acute care discharge locations, including for stroke survivors. Using AMPAC 6-Clicks, this study explores if stroke survivors with social vulnerabilities are less likely to discharge to an acute rehabilitation unit (ARU).
DESIGN: Retrospective observation study at an urban, primary stroke center and safety net hospital with adults admitted for acute stroke and medically stable for therapy.
METHOD: Therapy referrals in 2022–2023 had 267 subjects meeting inclusion (≥18 years, acute transient ischemic attack, stroke or intracranial hemorrhage) and exclusion criteria (non-acute stroke). Likelihood models analyzed discharge recommendations and locations to provide recommendation accuracy. Additional chart review for those recommended to ARU but discharged elsewhere (n = 59) had percentages calculated for medical/social factors affecting discharge.
RESULTS: Recommendations for home discharge were 97.7% accurate (94.8% likelihood) with the standard error (SE = 0.0132) close to the residual (0.0287), showing the model predicts the outcome well. When ARU was recommended, this discharge was 56.6% accurate. Those recommended to ARU (n = 116) but not discharged to ARU (n = 59) showed medical comorbidities (82.05%), lack of referral to ARU (66.1%), low functional baseline (15.38%), low income (12.82%), inadequate insurance (10.26%), poor social supports (7.69%), and homeless (2.56%). OT evaluation AMPAC 6-Clicks of those discharged to ARU was a 14.74 average and those who discharged elsewhere was an 18.22 average.
CONCLUSION: Anticipating correct discharge locations guides OT practice, effective resource allocation, and evidence-based discharge planning. This study revealed a discharge recommendation discrepancy and questionable AMPAC 6-Clicks predictability, warranting review with a larger n value. Only through further study can this phenomenon be explained and the question of equitable access to care be resolved.
References
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Hayes, H. A., Marcus, R., Stoddard, G. J., McFadden, M., Magel, J., & Hess, R. (2022). Is the Activity measure for postacute care ‘6-Clicks’ tool associated with discharge destination postacute stroke?. Archives of Rehabilitation Research and Clinical Translation, 4(4), 100228. https://doi.org/10.1016/j.arrct.2022.100228
Warren, M., Knecht, J., Verheijde, J., & Tompkins, J. (2021). Association of AM-PAC ‘6-Clicks’ basic mobility and daily activity scores with discharge destination. Physical Therapy & Rehabilitation Journal, 101(4), pzab043. https://doi.org/10.1093/ptj/pzab043
