on October 7, 2004
Published online before print October 7, 2004, doi: 10.1161/01.STR.0000145200.02380.a3
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Submitted on April 2, 2004
From the Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, and the Department of Physical Medicine and Rehabilitation and Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, Ill. * To whom correspondence should be addressed. E-mail: r-bode{at}northwestern.edu.
Background and Purpose--The purpose of this study was to evaluate the relative importance of therapy focus, intensity, and length of stay on greater than expected functional gain, controlling for stroke severity. Methods--This observational study included 198 first-stroke patients who were recruited from 8 in-patient rehabilitation facilities and 5 subacute programs. Stroke severity (motor, sensory and cognitive impairment) at admission was measured using an instrument combining all 3 aspects; self-care, mobility, and cognitive status at admission and discharge were measured with the Functional Independence Measure. Time spent by physical, occupational, and speech-language therapists on function- and impairment-focused activities were used to compute therapy intensity by discipline and type of activity. Residual change scores, estimated by regressing discharge on admission functional status, were modeled using patient and therapy characteristics. Results--Controlling for the stroke severity, greater than expected gains in self-care were predicted by longer lengths of stay and more intensive function-focused occupational therapy, and greater than expected cognitive gains were predicted by longer stays alone. Predictors of residual change in mobility, however, differed by gender: greater than expected gains in mobility for men were predicted by longer lengths of stay and more intense function-focused physical therapy whereas, for women, they were predicted by stroke severity alone. Conclusions--Unlike previous studies using raw functional gains, therapies accounted for a significant proportion of the variance in residual functional change. The results support studies suggesting that both content and amount of therapy are important aspects.
Revised on July 14, 2004
Accepted on July 22, 2004
Relative Importance of Rehabilitation Therapy Characteristics on Functional Outcomes for Persons With Stroke
Rita K. Bode PhD*;
Key words: rehabilitation • stroke • stroke outcome
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