The effects of a stroke unit on activities of daily living

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Abstract
Objective: To determine whether specific daily activities are improved more by treatment in a specialized stroke unit for patients seen after stroke. Design: Randomized controlled study allocating patients to management in a stroke unit or on conventional hospital wards. Setting: District general hospital medical or geriatric wards, or a hospital stroke unit. Subjects: Patients who within five weeks of acute stroke were considered suitable for intensive stroke unit rehabilitation (if so randomized). Interventions: Standard rehabilitation as delivered in the medical/geriatric wards or as delivered in the stroke unit. Outcome measures: All individual items from the Barthel activities of daily living (ADL) scale, all items from the Rivermead ADL scales (self-care and household sections) and all items from the Nottingham Extended ADL scale were analysed. Results: One hundred and seventy-six patients were seen in the stroke unit and 139 on the conventional wards. At entry the stroke unit had more women and stroke unit patients had less good arm function; otherwise the groups were comparable. The main differences were in the areas of feeding, dressing and household activities. Conclusions: Stroke unit rehabilitation seems to improve feeding, dressing and household activities more than occurs on conventional wards; mobility was improved equally in both settings.