The influence of stroke unit rehabilitation on functional recovery from stroke

BACKGROUND AND PURPOSE

Shorter lengths of hospital stay in stroke units could be due to quicker functional recovery or mechanisms of expediting hospital discharge.

METHODS

Stroke survivors with an intermediate prognosis at 2 weeks after stroke (n = 146) were randomized for management in a stroke rehabilitation unit or in general wards. Barthel scores were monitored at weekly intervals until hospital discharge. The duration and type of physiotherapy and occupational therapy received by patients in either setting were also recorded. The rate of change of Barthel scores, therapy input, and the duration of hospital stay were compared between the two settings.

RESULTS

Neurological deficits and median initial Barthel scores were comparable between patients in the stroke unit (n = 73) and general wards (n = 68). Median discharge Barthel score of patients managed in the stroke unit was significantly higher than that of patients managed in general wards (15 versus 12). Median Barthel scores in the stroke unit group rose rapidly after 2 weeks, reaching a plateau at 6 weeks. The change in median Barthel score in patients in general wards was significantly slower, reaching a plateau at 12 weeks despite similar therapy input. There was a significant delay in discharging stroke patients in general wards (20 weeks) compared with those in the stroke unit (6 weeks).

CONCLUSIONS

Functional recovery is significantly greater and more rapid in a stroke rehabilitation unit compared with general wards despite similar therapy input. These units also shorten hospital lengths of stay by expediting appropriate discharges.

Does age affect benefits of stroke unit rehabilitation?

BACKGROUND AND PURPOSE

The influence of age on benefits of stroke unit rehabilitation is largely unknown.

METHODS

A prospective controlled study was undertaken in 245 stroke survivors randomized to a stroke unit or to general wards 2 weeks after stroke. Patients were divided into older (75 years and over) and younger (under 75 years) age groups, and their characteristics, prognosis, duration, and type of therapy input and outcome were compared in different settings.

RESULTS

Younger (n = 101) and older (n = 144) stroke patients were comparable for neurological and functional deficits and were distributed equally between the stroke unit and general wards. The duration of therapy input was similar in younger patients in either setting. Older patients received more occupational therapy in both settings (10.7 +/- 2.4 versus 7.9 +/- 04.1) and more physiotherapy (18.4 +/- 9.6 versus 15.2 +/- 7.8) on general wards. Younger patients on the stroke unit showed better outcome compared with those on general wards (discharge home, 83% versus 60%; median Barthel score, 17 versus 13; median length of hospital stay, 27 versus 56 days) and with older patients on the stroke unit (discharge home, 83% versus 65%; median Barthel score, 17 versus 14). Outcome in older stroke patients was similar in both settings except for a shorter median length of hospital stay on the stroke unit (36 versus 84 days). Outcome in younger patients managed on general wards was worse than that in older patients with similar prognostic expectations (discharge home, 41% versus 61%; median Barthel score, 11 versus 13).

CONCLUSIONS

Younger stroke patients benefited more by stroke unit rehabilitation compared with older patients, not only because of their age but also because of differences in the multidisciplinary input available for elderly patients outside the stroke unit.