Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis

So when your doctor doesn't prescribe enough therapy you can beat her/him over the head with this paper.
http://jnnp.bmj.com/content/early/2015/06/11/jnnp-2015-310344.long

1. Stefan Knecht1,2,
2. Jens Roßmüller1,
3. Michael Unrath3,
4. Klaus-Martin Stephan1,
5. Klaus Berger3,
6. Bettina Studer1,2

+ Author Affiliations

1. ¹Department of Neurology, Mauritius Hospital, Meerbusch, Germany
2. ²Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany
3. ³Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany

1. Correspondence to Professor Stefan Knecht, St Mauritius Therapieklinik, Strümper Straße 111, Meerbusch 40670, Germany; Stefan.Knecht@stmtk.de

• Received 9 January 2015
• Revised 23 March 2015
• Accepted 8 April 2015
• Published Online First 11 June 2015

Abstract

Background and objective In current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age negatively impacts the benefit obtained from high-intensity neurorehabilitation. Our objective was to test this assumption empirically in a large sample of patients with stroke.

Methods Functional recovery during 4 weeks of inpatient neurorehabilitation was assessed with the Barthel Index (BI) in 422 middle-aged (<65 years), 1399 old (65–80 years) and 473 very old (>80 years) patients with stroke. Overall functional recovery, recovery patterns and the relationship between therapy intensity and recovery were statistically compared between the three age groups.

Results Overall functional recovery was statistically equivalent in middle-aged, old and very old patients (average improvement in BI total score: middle-aged: 15 points; old: 15 points; very old: 14 points). A novel item-wise logistic regression analysis (see Pedersen, Severinsen & Nielsen, 2014, Neurorehabil Neural Repair) revealed that this was true for 9 of the 10 everyday functions assessed by the BI. Furthermore, functional recovery was predicted by the amount of therapy (R=0.14; p=0.0001), and age did not moderate this relationship between therapy intensity and recovery (p=0.70).

Conclusions Old and even very old patients with stroke benefit from specialised inpatient neurorehabilitation and high amounts of therapy in the same degree as younger patients. Contrary to current clinical practice, old age should not be a criterion against admission to a neurorehabilitation unit following acute stroke treatment.