Stroke, Vol 24, 1462-1467, Copyright © 1993 by American Heart Association
L Kalra, P Dale and P Crome
BACKGROUND AND PURPOSE: Assessment of stroke rehabilitation is complicated
by the heterogeneity of patients and settings and by difficulties in
disentangling effects of organization from effects of types and amounts of
treatment input. METHODS: A prospective controlled study was undertaken in
245 stroke patients stratified into three groups according to prognosis and
managed on a stroke rehabilitation unit (n = 124) or general medical wards
(n = 121). Patients were randomly allocated to either setting 2 weeks after
stroke and were comparable for baseline characteristics. RESULTS: Patients
on general medical wards received more physiotherapy on average (16.2 +/-
7.2 versus 14.3 +/- 3.2 hours; P < .05) but similar amounts of
occupational therapy (9.3 +/- 2.8 versus 9.5 +/- 3.2 hours) compared with
stroke unit patients. More time was spent on individual rehabilitation on
the stroke unit compared with general wards (P < .001). Functional
abilities at discharge, destination of discharge, and length of hospital
stay in patients with good prognosis were comparable in both settings.
Patients with poor prognosis managed on general wards showed higher
mortality (P < .05) and longer hospital stay (123.2 +/- 48.2 versus 52.3
+/- 19.8 days; P < .001), but functional abilities at discharge in
survivors were comparable with those of stroke unit patients. Patients with
intermediate prognosis had significantly better outcome on the stroke unit,
with more patients being discharged home (75% versus 52%; P < .001),
shorter average length of hospital stay (48.7 +/- 17.2 versus 104.6 +/-
28.6 days; P < .001), and better functional abilities at discharge (P
< .05). CONCLUSIONS: Stroke units improve outcome and reduce hospital
stay without increasing therapy time. Their effectiveness may be enhanced
by patient selection.
ARTICLES
Improving stroke rehabilitation. A controlled study
Orpington Stroke Unit, Bromley Hospitals, UK.
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