277 Frailty and Early Supported Discharge (ESD) Post-Stroke: Are Frail Patients Referred to ESD and is Frailty Associated with Rehabilitation Outcomes?

Background Frailty presents in one in four stroke survivors and can be a determinant of recovery post-stroke. Healthcare services provided at home, instead of in hospitals, results in improved outcomes for frail patients. Early supported discharge (ESD) provides multidisciplinary rehabilitation at home post-stroke. It is unknown if frail stroke survivors receive ESD and if they benefit from it. The objectives were to evaluate the prevalence of pre-stroke frailty among ESD patients and examine if frailty is associated with rehabilitation outcomes. Methods Consecutive patients in the ESD programme were assessed for pre-stroke frailty using the Clinical Frailty Scale (CFS) from November 2018 to April 2019. Baseline characteristics and programme outcomes were recorded, including admission and discharge scores on the Functional Independence Measure and Functional Assessment Measure (FIM+FAM) and the Stroke Aphasia Quality of Life-39 measure (SAQOL-39). The duration of ESD rehabilitation and number of therapy sessions provided were also recorded. Distributions using Pearson’s Chi Squared test and associations using the Mann–Whitney U test were calculated. Results Results from 23 patients were analysed, median age 75±14.8 years, 82.6% male. The prevalence of frailty (CFS >5) was 4.3% (1/23) and pre-frailty (CFS=4) was 26.1% (6/23). Patients who were frail or pre-frail (CFS>4) were less likely to receive speech and language therapy (SLT) (z=-2.201; p=0.03) and have a lower SAQOL-39 on discharge (z=-2.294; p=0.02). No significant differences were noted in the FIM+FAM or the number of physiotherapy and occupational therapy sessions provided. Conclusion Frail patients are not routinely referred for ESD post-stroke. Patients who are pre-frail or frail make similar improvements with ESD compared to non-frail patient in functional independence but not quality of life. Comparable levels of physiotherapy and occupational therapy are provided but frail patients require less SLT. Further research is needed to ascertain if frail patients are appropriate for ESD.