Role of Stroke Rehabilitation Units in Managing Severe Disability After Stroke

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Abstract
Background and Purpose Stroke unit rehabilitation tends to be directed toward stroke patients with moderately severe disabilities (“the middle group”). Data collected on a stroke rehabilitation unit, however, showed improving outcome over 3 years in patients with a poor prognosis (discharge home: 48% versus 16%, P <.02; discharge Barthel Index score: 9 versus 6, P <.05). The hypothesis that stroke rehabilitation units may improve outcome in severely disabled stroke patients was tested in this study. Methods A randomized controlled study was undertaken in 71 patients with a poor prognosis who were treated either on a stroke rehabilitation unit (n=34) or on general wards (n=37) to compare outcome between the two groups. Data collected were also compared with those from a methodologically similar study undertaken 3 years ago. Results Severe stroke patients treated on the stroke rehabilitation unit had a significantly better outcome compared with general wards (mortality: 21% versus 46%, P <.05; discharge home 47% versus 19%, P <.01; median length of hospital stay: 43 versus 59 days, P <.02). The number of stroke unit patients being discharged home had increased significantly from the previous study, with a trend toward improvement in median discharge Barthel Index score. Conclusions Stroke rehabilitation units may improve outcome in severe stroke patients. This improvement appears to be due to the development of innovative management strategies that reduce mortality and institutionalization and enable caregivers to support more disabled stroke patients at home.