Functional Changes and Home Discharge After Inpatient Stroke Rehabilitation

Stroke is a major cause of disability, and discharge destination after inpatient rehabilitation is an important clinical and social outcome. In post-acute rehabilitation settings, integrated functional assessments are routinely performed during hospitalization, but there is limited evidence on whether the magnitude of functional improvement between admission and discharge is associated with home discharge among patients with stroke in Korean rehabilitation hospitals. This study is designed to address that gap using de-identified electronic medical record data from a post-acute rehabilitation hospital.

The primary purpose of this study is to investigate the association between changes in integrated rehabilitation functional assessment scores during hospitalization and discharge destination in patients with stroke. Specifically, the study will evaluate whether changes in Korean Modified Barthel Index (K-MBI), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Manual Function Test (MFT) are associated with home discharge versus transfer to another institution.

This is a retrospective observational study conducted at Zenith Hospital, a post-acute rehabilitation hospital in the Republic of Korea. The study population will include adult patients with stroke who were admitted to the rehabilitation ward and discharged between January 1, 2024 and March 31, 2025. Eligible participants must have integrated rehabilitation functional assessment data recorded in the electronic medical record at both admission and discharge. Patients with missing admission or discharge functional assessment data, terminal illness preventing rehabilitation, in-hospital death, or insufficient EMR data for analysis will be excluded.

The main independent variables are changes in functional assessment scores between admission and discharge, including delta K-MBI, delta FAC, delta BBS, delta MMSE, and delta MFT. The primary outcome is discharge destination, categorized as home discharge or transfer to another institution. Covariates available in the EMR, such as age, sex, length of stay, and stroke type, will also be analyzed as potential confounders.

The study procedures are as follows: the hospital medical records team will identify potentially eligible patients according to the inclusion and exclusion criteria; all direct identifiers will be removed from the EMR data; a study-specific de-identified code will be assigned; and only de-identified data will be provided to the investigator for analysis. The investigator will calculate functional changes and perform statistical analyses to identify factors associated with discharge destination. There will be no participant contact, no prospective enrollment, no survey administration, and no intervention assigned as part of this study.

The study has been reviewed and approved by the Public Institutional Bioethics Committee No. 1 designated by the Ministry of Health and Welfare (Approval No. P01-202512-01-054). The findings are expected to provide practical evidence for discharge planning, patient stratification, and community reintegration support in post-acute stroke rehabilitation.

Inclusion criteria

• Adults aged 19 years or older
• Patients with stroke who were admitted to and discharged from the post-acute rehabilitation ward at Zenith Hospital between January 1, 2024 and March 31, 2025
• Patients with integrated rehabilitation functional assessment data recorded in the electronic medical record at both admission and discharge, including Korean Modified Barthel Index (K-MBI), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Manual Function Test (MFT)

Exclusion criteria

• Missing admission or discharge functional assessment data
• Patients with terminal illnesses that made rehabilitation treatment infeasible, such as advanced cancer or end-stage heart failure
• In-hospital death or transfer before discharge assessment, resulting in no discharge functional assessment data
• Insufficient electronic medical record data for the study analysis