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on May 31, 2007

Stroke. 2007
Published online before print May 31, 2007, doi: 10.1161/STROKEAHA.107.482869
A more recent version of this article appeared on July 1, 2007
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Submitted on January 19, 2007
Accepted on February 26, 2007

Motor and Functional Recovery After Stroke. A Comparison of 4 European Rehabilitation Centers

Liesbet De Wit PT, PhD*; Koen Putman PT, PhD; Birgit Schuback PT, MSc; Arnost Komárek PhD; Felix Angst MD, MPH; Ilse Baert PT, MSc; Peter Berman MB, BS, FRCP; Kris Bogaerts MSc; Nadine Brinkmann PT, BSc; Louise Connell PT, BSc; Eddy Dejaeger MD, PhD; Hilde Feys PT, PhD; Walter Jenni MD; Christiane Kaske PT, BSc; Emmanuel Lesaffre PhD; Mark Leys PhD; Nadina Lincoln PhD; Fred Louckx PhD; Wilfried Schupp MD; Bozena Smith OT, MSc; and Willy De Weerdt PT, PhD

From Department of Rehabilitation Sciences (L.D.W., I.B., H.F., W.D.W.), Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium; Department of Health Sciences and Medical Sociology (K.P., M.L., F.L.), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium; RehaClinic Zurzach (B.S., F.A., C.K., W.J.), Switzerland; NHS Trust (P.B.) Nottingham, UK; Biostatistical Center (A.K., K.B., E.L.), Katholieke Universiteit Leuven, Belgium; Fachklinik Herzogenaurach (N.B., W.S.), Germany; Institute of Work, Health and Organisations (L.C. N.L., B.S.), University of Nottingham, Nottingham, UK; University Hospital Pellenberg (E.D.), Belgium.

* To whom correspondence should be addressed. E-mail: Liesbet.Dewit{at}faber.kuleuven.be.

Background and Purpose--Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers.

Methods--Consecutive stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing.

Results--Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center ({Delta}OR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center ({Delta}OR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center ({Delta}OR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers.

Conclusions--Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.


Key words: recovery • rehabilitation centers • stroke


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