This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sulch, D. Articles by Kalra, L. Search for Related Content PubMed PubMed Citation Articles by Sulch, D. Articles by Kalra, L. Pubmed/NCBI databases Medline Plus Health Information Managed Care Stroke Related Collections Health policy and outcome research Resource utilization Rehabilitation, Stroke

(Stroke. 2000;31:1929.)
© 2000 American Heart Association, Inc.

Original Contributions

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

David Sulch, MRCP; Inigo Perez, MD; Anne Melbourn, RGN Lalit Kalra, PhD, FRCP

From Guy’s, King’s and St Thomas’ School of Medicine, King’s College, London, UK.

Correspondence to Prof L. Kalra, Department of Medicine, Guy’s, King’s and St Thomas’ School of Medicine, Denmark Hill Campus, Bessemer Rd, London SE5 8PJ, UK. E-mail lalit.kalra{at}kcl.ac.uk

Background and Purpose—Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay.

Methods—An ICP for stroke rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (n=76) or conventional multidisciplinary care (n=76).

Results—The age, sex, premorbid functional ability, and stroke characteristics of the 2 groups were comparable. There were no differences in mortality rates (10 [13%] versus 6 [8%]), institutionalization (10 [13%] versus 16 [21%]), or length of hospital stay (50±19 versus 45±23 days) between patients receiving ICP or multidisciplinary care. Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks (median change in Barthel Activities of Daily Living Index 6 versus 2; P<0.01) and had higher Quality of Life scores at 12 weeks (65 versus 59; P=0.07) and 6 months (72 versus 63; P<0.005). There were no significant differences in the mean duration of physiotherapy (42.8±41.2 versus 39.4±36.4 hours) or occupational therapy (8.5±7.5 versus 8.0±7.5 hours) received between the 2 groups.

Conclusions—ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit. Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care.

Key Words: effectiveness • hospitalization • integrated care pathways • rehabilitation • stroke

This article has been cited by other articles:

				S K Baxter and S M Brumfitt Benefits and losses: a qualitative study exploring healthcare staff perceptions of teamworking Qual. Saf. Health Care, April 1, 2008; 17(2): 127 - 130. [Abstract] [Full Text] [PDF]

				British Thoracic Society Guideline Development Gro Intermediate care--Hospital-at-Home in chronic obstructive pulmonary disease: British Thoracic Society guideline Thorax, March 1, 2007; 62(3): 200 - 210. [Full Text] [PDF]

				R. J O'Connor and V. C Neumann Payment by results or payment by outcome? The history of measuring medicine. J R Soc Med, May 1, 2006; 99(5): 226 - 231. [Full Text] [PDF]

				J. Kwan and P. Sandercock In-Hospital Care Pathways for, Stroke: An Updated Systematic Review Stroke, June 1, 2005; 36(6): 1348 - 1349. [Full Text] [PDF]

				D. U Jette, N. K Latham, R. J Smout, J. Gassaway, M. D Slavin, and S. D Horn Physical Therapy Interventions for Patients With Stroke in Inpatient Rehabilitation Facilities Physical Therapy, March 1, 2005; 85(3): 238 - 248. [Abstract] [Full Text] [PDF]

				D. B. Matchar Health Policy in Stroke: Translating What We Know Into What We Do Stroke, February 1, 2003; 34(2): 370 - 371. [Full Text] [PDF]

				J. Kwan and P. Sandercock In-Hospital Care Pathways for Stroke: A Cochrane Systematic Review Stroke, February 1, 2003; 34(2): 587 - 588. [Full Text] [PDF]

				D. Sulch, A. Melbourn, I. Perez, and L. Kalra Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit Stroke, June 1, 2002; 33(6): 1600 - 1604. [Abstract] [Full Text] [PDF]

				L. A. Gillum and S. C. Johnston Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes Stroke, September 1, 2001; 32(9): 2137 - 2142. [Abstract] [Full Text] [PDF]

				M. Shaw Integrated care pathway based rehabilitation for acute stroke did not reduce length of hospital stay Evid. Based Nurs., April 1, 2001; 4(2): 53 - 53. [Full Text]