From the Foundation for Health Services Research, Central Hospital of
Akershus, Norway.
Correspondence to Ole Morten Rønning, Department of Neurology, Central Hospital of Akershus, 1474 Nordbyhagen, Norway. E-mail bguldvog{at}sia.pilot.akershus-f.kommune.no
Methods—251 patients initially treated in the hospital were
randomized to subacute rehabilitation in a hospital rehabilitation
unit (n=127) or to the health services in the municipality (n=124) and
were followed up for 7 months.
Results—The combined outcome of patients being dead or dependent
(Barthel Index score of <75) was 23% in the hospital group and 38%
in the municipality group (P=.01). Seven-month survival
rates were 90.6% and 83.9% (P=.11), respectively.
Dependency in activities of daily living was 12.6% in the hospital
group and 25.0% in the municipality group (P=.07).
Patients with a BI score of <50 before rehabilitation had
significantly better outcome in the hospital rehabilitation unit, with
fewer patients becoming dependent (P=.005) and patients
having higher Scandinavian Stroke Scale (P=.026) and BI
scores (P=.005). No significant differences in
health-related quality of life were found. Many patients treated in the
municipalities (30%) did not receive any organized rehabilitation in
this study.
Conclusions—Subacute rehabilitation of stroke patients in a
hospital-based rehabilitation unit improves outcome. Patients with
moderate or severe stroke appear to benefit most.
It has been maintained that the patients most appropriate for
subacute rehabilitation are those with moderately severe
deficits,7 although one particular
study9 showed that severely disabled patients
with a poor prognosis had a better outcome when treated in a stroke
rehabilitation unit. A subgroup analysis of an overview of
stroke trials showed that stroke severity was not associated with the
effectiveness of the treatment.1
The resources available for long-term rehabilitation may be
limited by an increasing number of stroke patients. Few randomized
controlled studies exist that evaluate management of stroke patients
after the acute treatment.2 7 11 12 13 In these
studies the groups that were offered specialized subacute stroke
rehabilitation had fewer deaths and better functional outcome (although
not to a level of significance in each trial). One
study13 has shown that specialist community
rehabilitation after the acute treatment is clinically as effective as
hospital care. The Stroke Unit Trialists'
Collaboration1 showed that admission of stroke
patients a week or more after a stroke did not eliminate the
effectiveness of the stroke unit care.
It is therefore still under debate whether patients in the subacute
phase should be offered rehabilitation in their local environment or in
hospital-based rehabilitation units14 15 and
which level of rehabilitation is proper for different
subgroups.16 We have previously shown that
treatment in an acute stroke unit with a length of stay of
approximately 7 days reduces mortality17 and
neurological but not functional deficits.18 We
considered the length of stay in the acute stroke unit to be too short
to affect functional disability.
This study was performed to assess the efficacy of a hospital-based
rehabilitation program in reducing neurological impairment and
functional disability and increasing health-related quality of life
among patients with subacute stroke. We also wanted to determine
whether severity influenced the benefit of a rehabilitation unit with a
subacute rehabilitation program.
Stroke patients were assessed on arrival by members of the
multidisciplinary team to identify problems affecting activities of
daily living, speech problems, and disturbances affecting their
living at home. Spouses participated routinely in meetings. Long- and
short-term goals were planned, and each patient had one therapist
coordinating the rehabilitation. The Bobath
technique20 was considered the most appropriate,
and the staff was instructed in this technique, which was the main
approach for physical and functional rehabilitation.
Rehabilitation in Municipalities
Allocation of Stroke Patients
The primary outcome measures assessed 7 months after onset were death,
need of long-term care, and number of patients disabled (BI score of
<75). Secondary outcomes were neurological deficits, functional
disability, and quality of life. The SSS22 and
BI23 were used to assess neurological deficits
and personal activities of daily living. The Medical Outcomes Study
Short Form (SF-36) physical and mental health summary
scales24 were used tomeasure health-related
quality of life 7 months after stroke. Assessment at 7 months was
performed by the primary investigator (O.M.R), who was unaware of where
the patients had been treated and their previous scores.
The study was approved by the Ethical Committee for Medical Research
(approval S-93231) and supported by the National Association Against
Heart and Vascular Diseases.
Statistical Analysis
Table 2
Some patients suffered serious deterioration in their condition
after inclusion in this study and before they could take part in the
rehabilitation program; hence, they could not cooperate in the
rehabilitation. These patients were evaluated as having been treated in
the rehabilitation unit, although they did not receive such treatment.
Some of the stroke patients improved during acute treatment in the
stroke unit or general medical ward and did not want to participate in
a rehabilitation program, or they were not offered such treatment
because they had improved to a level at which a rehabilitation program
was unnecessary. To avoid selection bias, these patients were not
excluded but were analyzed within the group to which they were
randomized. The BI and SSS assessments before patient transfer to late
rehabilitation were performed without knowledge of the groups to which
patients had been allocated. Patients randomized to hospital
rehabilitation had lower BI scores (although not significantly so) than
those randomized to the control group; however, they caught up with the
municipality rehabilitation group, reaching the same median BI score
after 7 months. There was no significant difference in any of the
subscores of the domains of the SF-36. In contrast to other studies,
this study did not show a reduction in the need of long-term care at 7
months after stroke.
Results were not due to differences in patient characteristics or in
acute treatment before admission to the rehabilitation unit. The total
amount of treatment offered to the hospital-based rehabilitation group
seemed to exceed that offered to the control group during the 7-month
period. As shown in Table 5
The results of this study come as supplementary findings to the results
in our stroke unit trial, in which we showed that a stroke unit was
effective in reducing death17 and hastening
neurological recovery,18 and in which the
difference in reduction of these deficits occurred during the acute
treatment within the first 5 days after stroke.18
The effect of treatment in the rehabilitation unit on dependency is not
due to survival of the patients with the best prognosis, since more
patients survived in the hospital rehabilitation group, and hence
probably more patients with initially severe strokes survived in this
group (Table 2
We do not know the reason for the difference in mortality between the
two groups. Patients who stayed in the hospital had access to expert
medical services 24 hours a day. Some medical complications may have
been detected and treated more often and sooner among patients in the
hospital rehabilitation unit. Medical adjustments were probably made
more thoroughly among these patients, since it was possible to follow
them daily for several weeks. The treatment offered to the control
group was likely to be quite heterogeneous, because they
were transferred to different municipalities with varying degrees of
competence in the management of stroke patients and differences in
economic and personnel resources. Although the rehabilitation of
disabled stroke patients should follow guidelines for such treatment,
some differences in strategies of rehabilitation may have occurred.
In our hospital the number of beds in the general rehabilitation unit
is limited, thus many stroke patients do not receive rehabilitation
after the acute treatment. The staff at the rehabilitation department
had previously observed that patients who showed some degree of
improvement during the first days after stroke often benefited most
from rehabilitation. As a consequence, these patients were more
frequently offered rehabilitation. It might well be that the unit
selected patients for rehabilitation who already had a good prognosis
of recovery, whether they received hospital rehabilitation or not. In
our study it appears that the most appropriate patients for
subacute hospital-based rehabilitation are those with an
intermediate prognosis.
We conclude that patients with acute stroke initially treated in a
stroke unit or general medical ward for a relatively short length of
time benefited from treatment in a hospital-based specialist
rehabilitation facility compared with treatment through a package of
municipality-based services. Patients with moderate or severe stroke
benefited more than those with mild stroke.
Hospital-based rehabilitation of patients with subacute stroke
appears to be effective, but its efficacy could be improved by patient
selection. Some of the results observed could be due to differences in
the quantity of rehabilitation offered. Further research is needed to
clarify the effectiveness of a hospital-based rehabilitation unit and
to determine whether certain patient groups benefit more than
others.
Received September 30, 1997;
revision received January 12, 1998;
accepted January 12, 1998.
2.
Juby LC, Lincoln NB, Berman P. The effect of a stroke
rehabilitation unit on functional and psychological outcome: a
randomised controlled trial. Cerebrovasc Dis. 1996;6:106–110.
3.
Aitken PD, Rodgers H, French JM, Bates D, James OFW.
General medical or geriatric unit care for acute stroke? A controlled
trial. Age Ageing. 1993;22(suppl 2):4–5.
4.
Hankey G, Deleo D, Stewart-Wynne EG. Acute hospital
care for stroke patients: a randomised trial. Cerebrovasc
Dis. 1995;5:228. Abstract.
5.
Garraway WM, Akthar AJ, Hockey L, Prescott RJ.
Management of acute stroke in the elderly: follow-up of a controlled
trial. BMJ. 1980;281:827–829.
6.
Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim
LL, Holme I. Benefit of a stroke unit: a randomized controlled trial.
Stroke. 1991;22:1026–1031.
7.
Kalra L, Dale P, Crome P. Improving stroke
rehabilitation: a controlled study. Stroke. 1993;24:1462–1467.
8.
Kalra L. The influence of stroke unit rehabilitation
on functional recovery from stroke. Stroke. 1994;25:821–825.[Abstract]
9.
Kalra L, Eade J. Role of stroke rehabilitation units
in managing severe disability after stroke. Stroke. 1995;26:2031–34.
10.
Wade DT. Is stroke rehabilitation worthwhile?
Curr Opin Neurol Neurosurg. 1993;6:78–82.[Medline]
[Order article via Infotrieve]
11.
Feldman DJ, Lee PR, Unterecker J, Lloy K, Rusk HA,
Toole A. A comparison of functionally orientated medical care and
formal rehabilitation in the management of patients with hemiplegia due
to a cerebrovascular disease. J Chron Dis. 1962;15:297–310.[Medline]
[Order article via Infotrieve]
12.
Sivenius J, Pyörälä K, Heinonen OP,
Salonen JT, Riekkinen P. The significance of intensity of
rehabilitation of stroke: a controlled trial. Stroke. 1985;16:928–931.
13.
Rudd AG, Wolfe CDA, Tilling K, Beech R. Randomised
controlled trial to evaluate early discharge scheme for patients with
stroke. BMJ. 1997;315:1039–1044.
14.
Wade DT, Langton-Hewer R, Skilbeck CE, Bainton D,
Burns-Cox C. Controlled trial of a home-care service for acute stroke
patients. Lancet. 1985;1:323–326.[Medline]
[Order article via Infotrieve]
15.
Young J. Is stroke better managed in the community?
Community care allows patients to reach their full potential.
BMJ. 1994;309:1356–8.
16.
Alexander MP. Stroke rehabilitation outcome: a
potential use of predictive variables to establish levels of care.
Stroke. 1994;25:128–34.[Abstract]
17.
Rønning OM, Guldvog B. Stroke units versus
general medical wards, I: twelve- and eighteen-month survival: a
controlled trial. Stroke. 1998;29:58–62.
18.
Rønning OM, Guldvog B. Stroke units versus general
medical wards, II: neurological deficits and ADL: a quasi-randomized
controlled trial. Stroke. In press.
19.
Official Statistics of Norway. Oslo, Norway: Statistics
Norway; 1994.
20.
Bobath B. Adult Hemiplegia: Evaluation and
Treatment. 2nd ed. London, UK: William Heineman Medical Books Ltd;
1978.
21.
WHO Special Report. Stroke: recommendations on stroke
prevention, diagnosis, and therapy. Stroke. 1989;1989:20:1407–1431.
22.
Scandinavian Stroke Study Group. Multicenter trial of
hemodilution in acute ischemic stroke: background and study
protocol. Stroke. 1985;16:885–90.
23.
Mahoney F I, Barthel D W. Functional evaluation: the
Barthel Index. Md Med J. 1965;14:61–65.
24.
Ware JE. SF-36 physical and mental health summary
scales: a users manual. Boston, Mass: The Health Institute, New England
Medical Center; December 1994.
© 1998 American Heart Association, Inc.
Original Contributions
Outcome of Subacute Stroke Rehabilitation
A Randomized Controlled Trial
Abstract
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Background and Purpose—Organized
acute stroke treatment reduces mortality, functional deficits, and the
need of institutionalization after stroke. It is largely unknown
whether the effects of treatment are due to early or subacute
efforts. The aim of this randomized, controlled study was to test the
hypothesis that rehabilitation of stroke patients in the subacute
phase in a hospital rehabilitation unit is beneficial in reducing death
and dependency and increasing health-related quality of life.
Key Words: rehabilitation • stroke management • stroke outcome
Introduction
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Studies of services
specialized in caring for patients with acute stroke show that
well-organized management reduces mortality, neurological deficits,
functional disability, and long-term institutional
care.1 2 3 4 5 6 7 8 9 Still remaining unanswered are the
questions of which components in the care of acute stroke patients are
effective,1 where and how rehabilitation of
stroke patients in the subacute period should take place, and
whether all stroke patients should be offered subacute coordinated
multidisciplinary rehabilitation.10
Subjects and Methods
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Hospital Rehabilitation
The 18-bed rehabilitation unit is localized in the Central
Hospital of Akershus in Norway, which serves a population of 291 905,
of whom 49 303 are 60 years or older.19 The unit
is a generalized rehabilitation unit, physically separated from the
stroke unit, which rehabilitates patients with a disabling illness but
is not exclusively for stroke patients. Six beds were reserved for this
stroke rehabilitation study. Patients transferred to the rehabilitation
unit had access to a coordinated multidisciplinary rehabilitation team
of nurses; physical, occupational, and speech therapists; a social
worker; and a neurologist. The staff is specially trained to treat and
rehabilitate stroke patients, and they take part in education programs
to improve their knowledge of stroke. In this hospital, stroke
treatment is organized with initial acute treatment in an acute stroke
unit or a general medical ward with a relatively short length of stay;
thereafter, patients are selected to be transferred to a rehabilitation
unit with a longer rehabilitation period (Fig 1
).18
View larger version (32K):
[in a new window]
Figure 1. Diagram of patient flow. *Indicates randomization
to late rehabilitation before acute treatment.
The catchment area of the hospital consists of 20 municipalities
with populations ranging from 3000 to approximately 50 000. The local
authorities are responsible for primary health care, which includes
rehabilitation of disabled patients. Most municipalities have a nursing
home that provides rehabilitation through a multidisciplinary staff. In
one region of the County of Akershus, stroke patients had access to
very specialized rehabilitation services within a rehabilitation
center. The rehabilitation services offered to stroke patients
consisted of nursing home rehabilitation, on either an inpatient or
day-patient basis, and further ambulatory rehabilitation by a visiting
physical therapist, speech therapist, and/or nurse (Table 2).
Municipalities are instructed by legislation and regulations to offer
access to primary health care, including physical therapy, occupational
therapy, speech therapy, and nurse support. Most municipalities comply
with these directions, but some have difficulties with limited
capacity. There was thorough communication between the hospital and the
primary health care provider before transfer of the patient to the
community. For stroke patients with speech disorders, the speech
therapist in the hospital obtained information about follow-up in the
community.
View this table:
[in a new window]
Table 2. Outcome by Treatment Groups 7 Months After Stroke
The inclusion and randomization procedures took place within the
first day after admission to the hospital. The study was limited to
acute stroke patients 60 years of age or older, with a Scandinavian
Stroke Scale (SSS) score between 12 and 52, who were conscious on
admission, and patients who could cooperate in the rehabilitation
program (ie, those who scored at least 4 points on the subject
orientation section of the SSS). The first assessment was performed by
the practitioner on duty; hence, inclusion to the trial
could not be biased by the investigators. Two prognostic groups were
calculated (Barthel Index [BI]) scores of <50 and 
50) on the basis
of the BI score recorded on day 1 after stroke. Patients with
recurrent strokes and with malignant diseases not in the terminal
stages were also included. Stroke victims who were comatose or
somnolent on admission were not included in this study, even if they
showed improvement in consciousness during the first few days after
hospitalization. Patients admitted from nursing homes were not
included. The patient or a relative gave informed consent. None of the
patients refused to participate. Patients were given a random number,
and twice weekly a person (E.L.) not involved in the treatment or
investigation drew numbers for allocation of eligible patients to the
rehabilitation unit or to community-based rehabilitation. If the
hospital rehabilitation unit was full, patients who were selected for
hospital rehabilitation were instead offered rehabilitation in the
municipality (n=13). These patients, as all other patients in this
study, were not excluded but were analyzed on an
intention-to-treat basis. Subjects were recruited from 550 patients
aged 60 years who had been admitted to the hospital within 24 hours
after an acute stroke between March 1, 1994, and December 31, 1995. Two
hundred fifty-one of these patients fulfilled the inclusion criteria
and were randomized to the study (Fig 1
). Stroke was defined according
to WHO criteria.21 All patients were examined
with use of a CT scan. Thirty-two patients died before the end of
observation, and 19 patients (12 from the municipality group) were not
assessed clinically after 7 months because they were not reached or did
not respond to repeated contact by telephone or mail (14), did not want
to travel to a hospital (4), or had moved out of the district (1).
Tests used included Student t tests for comparison of
continuous data and the 
2 test for comparison
of categorical data. The Mann-Whitney test was performed to compare the
difference in the median value of the SSS and BI scores between
treatment groups. Kaplan-Meier survival curves were calculated, and the
difference between curves was analyzed with the log-rank test.
Intention-to-treat analysis was performed for all 251
patients.
Results
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Fig 1 shows the study randomization and patient flow. Table 1 shows the demographic characteristics,
prior medical history, and SSS and BI scores before rehabilitation for
127 patients randomized to hospital-based rehabilitation and 124
patients randomized to municipality-based rehabilitation. Mean length
of stay in the hospital before transfer to hospital- or
municipality-based rehabilitation was 9.4 days and 10.4 days,
respectively. The same proportion of patients in the two groups
received treatment in the stroke unit before rehabilitation.
Distributions of type and severity of strokes were similar for both
treatment groups (Table 1). Patients randomized to receive
hospital-based rehabilitation stayed in the rehabilitation ward for a
mean of 27.8 days. The SSS and BI scores before rehabilitation did not
differ between the groups for the 19 patients who were lost to
follow-up.
View this table:
[in a new window]
Table 1. Characteristics of Eligible Stroke Patients
Randomized to the Study Groups shows the outcomes at 7 months.
There were differences in the proportions of deaths and patient
dependence between the two groups in favor of the hospital
rehabilitation group. The differences were not significant. For the
combined outcome of dependent or dead, there was a significantly better
result in the group treated in the hospital. We performed an
analysis in which we included missing patients and assumed they
were alive and dependent. The combined outcome (death or dependence)
was still in favor of the hospital rehabilitation group (odds ratio,
0.53; 95% confidence interval, 0.31 to 0.93). Median SSS was 54 and
median BI was 95 in both groups 7 months after stroke. Table 3 shows the outcome for the subgroups of
patients with moderate or severe stroke (BI <50) and those with mild
stroke (BI 50). The table shows that patients with moderate and
severe stroke benefit most of rehabilitation in hospital on the
outcomes dependent (P=.005), dependent or dead
(P=.002), BI (P=.005), and SSS
(P=.026), whereas for patients with mild stroke there were
no differences except for the need of long-term care. Table 4 describes the self-reported
health-related quality of life 7 months after stroke. Of the 115
survivors from the hospital rehabilitation group and the 104 survivors
from the municipality rehabilitation group, 82 (71%) and 65 (63%),
respectively, were able and willing to complete the SF-36. Table 5 shows the treatment offered to patients
treated in the municipality. The proportion of patients in the
municipality group who were treated as inpatients was 41%. Of the
remaining 59% who were treated as outpatients, 30% reported that they
did not receive any specific stroke rehabilitation. Survival curves
with P values are shown in Fig 2.
View this table:
[in a new window]
Table 3. Outcome According to Prognostic Group
View this table:
[in a new window]
Table 4. SF-36 Scores by Treatment Group 7 Months After
Stroke
View this table:
[in a new window]
Table 5. Treatment Offered to the Municipality-Based
Rehabilitation Group after Discharge From Hospital
View larger version (15K):
[in a new window]
Figure 2. Graph showing survival from 0 to 180 days after
stroke in patients (n=251) treated in hospital-based rehabilitation
unit (solid line) and municipality-based rehabilitation (dotted line).
P values are shown at 30-day periods.
Discussion
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
This randomized, controlled study shows a benefit of early
transfer of patients with acute stroke to a specialty rehabilitation
unit within a hospital compared with community-based rehabilitation.
The study was restricted to patients with an initial SSS score between
12 and 52 but represented more than half of the patients
with stroke admitted to hospital during the study period. Seven-month
outcome showed that hospital rehabilitation in the subacute phase
was effective in reducing the combined outcome of death or dependence
but not in reducing the need for long-term care. Patients with a
moderate or severe stroke had a significant reduction in dependency,
improvement of neurological deficits (measured by SSS), and improvement
in activities of daily living (measured by BI). Municipality-based
rehabilitation seemed as effective as hospital-based rehabilitation for
patients with mild stroke, but a ceiling effect of the BI is apparent
for this group. By dividing the chain of treatment into an acute phase
and a subacute phase, we were better able to document the specific
contributions of each stage of treatment. Patients were treated in
either a stroke unit or a general medical ward before transfer to
long-term rehabilitation. We show that there is no statistically
significant difference in functional outcome related to the initial
treatment before admission to the rehabilitation unit (Table 1). , 41% of the municipality-based
rehabilitation group were treated as inpatients, but as many as 30%
did not receive any organized rehabilitation. ). The results of our trial concur with those of many
stroke unit trials,1 but both the intervention
and the control groups in our study differ from those in the trials,
because the acute treatment preceded rehabilitation. Our study
contrasts with one evaluating early discharge from the hospital with
specialist rehabilitation at home, which showed this method to be as
effective as conventional treatment.13 Another
British study did not show specific advantages of home-care services
over hospital-based care.14
Acknowledgments
This study was supported by grants from the National Association
for Heart and Vascular Diseases. We acknowledge the helpful comments of
M.A. Joten and the valuable assistance of E. Lier (Department of
Neurology, Central Hospital of Akershus).
References
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
1.
Stroke Unit Trialists' Collaboration.
Collaborative systematic review of the randomised trials of organised
inpatient (stroke unit) care after stroke. BMJ. 1997;314:1151–9.
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