Abstract
There
is a revolution underway in stroke rehabilitation. International
comparative studies coupled with an impressive evidence base have
provided a platform from which an ideal system for stroke rehabilitation
can be envisioned. Using the concepts of structure and process of care,
different systems of stroke rehabilitation can be compared and
evaluated against best evidence. Two structures of care are examined:
specialized interdisciplinary stroke rehabilitation units and outpatient
programs. Although specialized interdisciplinary stroke rehabilitation
units remain the "gold standard" of care, access to them is often
limited. Outpatient programs are essential to stroke rehabilitation
systems of care; however, while some countries are investing in
outpatient programs, others are scaling back. Even though structures of
care have been shown to affect processes of care, it is the processes of
care that have proven to be more influential in altering patient
outcomes. Four key processes of care are examined: time to admission,
intensity of therapy, task-specific therapy, and discharge planning.
Within international stroke rehabilitation systems, differences in these
processes have resulted in significant differences in outcomes. This
allows for "real-world" comparisons of how differing processes affect
patient outcomes. Those systems whose structures and processes of care
best reflect current best evidence appear to achieve better outcomes.
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