Does the NRS Capture Changes in Communication during Inpatient Stroke Rehabilitation?

Abstract

Background: In Ontario, the National Rehabilitation Reporting System (NRS) is mandated for use as a measurement of change for stroke patients after admission to and discharge from rehabilitation. The NRS includes the functional independence measure (FIM) and supplementary measurement items developed by the Canadian Institute for Health Information (CIHI). Uncertainty exists regarding the efficacy of the NRS as the sole measure of outcome for communication in stroke rehabilitation patients. The use of additional speech-language pathology outcome measurement tools for this population has therefore been suggested.

Objectives: This study sought to establish whether the FIM and CIHI communication items capture quantifiable gains during stroke rehabilitation and therefore whether additional measures are needed to assess outcomes.

Methods: A retrospective analysis was completed of 1252 complete data records of stroke patients discharged from inpatient rehabilitation at Hamilton Health Sciences between 2006 and 2011.

Results and impact: Statistically significant improvements were observed in all total matched FIM scores (M = 72.68 to M = 96.39, P < .001) and for each expression (M = 4.61 to M = 5.35, P < .001) and comprehension (M = 4.69 to M = 5.33, P < .001) subscale. The most severely affected group demonstrated the greatest gains. These findings were independent of stroke severity. Additional outcome measurement tools for communication are therefore not required to assess outcomes in rehabilitation of stroke patients, although additional research is necessary to evaluate the clinical significance of the improvements that are observed using existing measurements of change.

Keywords: CIHI; FIM; NRS; communication; outcome; speech-language pathology; therapy.