Impact of COVID-19 positive status on outcome for individuals with stroke treated in acute inpatient rehabilitation

Background: Stroke, whether or not accompanied by concurrent COVID-19 infection, has been associated with varying acute care outcomes, with patients who are COVID-19 positive typically faring worse. This study aims to explore the functional outcomes of patients with stroke —with and without simultaneous COVID-19 infection—who survived their acute care stay and progressed to acute inpatient rehabilitation (IRF). Objectives: To identify differences in sociodemographic factors, medical complexity, and rehabilitation outcomes from an IRF stay between patients with stroke with concurrent COVID-19 and those without. Design: A retrospective, observational cohort study using electronic medical records (EMR) data. Setting: EMR data from 138 IRFs across 34 states of the United States and Puerto Rico involving 40,282 individuals following stroke discharged between April 1, 2020 and May 31, 2021 of whom 1483 (3.7%) were COVID-19 positive. Participants: NA. Interventions: NA. Main Outcome Measures: Variables collected included sociodemographic and medical complexity along with outcome variable categories included functional complexity, process outcomes, and functional abilities. Results: Significant differences were found between the two groups using standardized effect sizes >0.2. COVID-19 positive patients with stroke had more comorbidities (94.1% vs. 51.8%, standardized effect = 1.1), lower admission mobility (26 vs. 30, standardized effect = 0.27), lower discharge mobility scores (56 vs. 65, standardized effect = 0.27), and a longer IRF stay (17 days vs. 14 days, standardized effect = 0.30). They also were less likely to return to the community (65.5% vs. 78.3%) but had a higher acute care transfer rate (19.1% vs. 10.6%). Logistic regression showed that Hispanic COVID-positive individuals and those with higher mobility scores were more likely to be discharged to the community. Conclusions: There are meaningful differences in rehabilitation outcomes between COVID–19 positive and negative individuals with stroke that clinicians can use to better understand, anticipate and mitigate outcome challenges facing the COVID-19 positive population with stroke.