Outcome of Subacute Stroke Rehabilitation

2 things to note from this;
1. The doctor does nothing.
2. Nowhere are protocols referred to, so this research is not repeatable.
http://stroke.ahajournals.org/content/29/4/779.long

Ole Morten Rønning, Bjørn Guldvog

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https://doi.org/10.1161/01.STR.29.4.779

Stroke. 1998;29:779-784

Originally published April 1, 1998

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Abstract

Background and Purpose—Organized acute stroke treatment reduces mortality, functional deficits, and the need of institutionalization after stroke. It is largely unknown whether the effects of treatment are due to early or subacute efforts. The aim of this randomized, controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life.

Methods—251 patients initially treated in the hospital were randomized to subacute rehabilitation in a hospital rehabilitation unit (n=127) or to the health services in the municipality (n=124) and were followed up for 7 months.

Results—The combined outcome of patients being dead or dependent (Barthel Index score of <75) was 23% in the hospital group and 38% in the municipality group (P=.01). Seven-month survival rates were 90.6% and 83.9% (P=.11), respectively. Dependency in activities of daily living was 12.6% in the hospital group and 25.0% in the municipality group (P=.07). Patients with a BI score of <50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit, with fewer patients becoming dependent (P=.005) and patients having higher Scandinavian Stroke Scale (P=.026) and BI scores (P=.005). No significant differences in health-related quality of life were found. Many patients treated in the municipalities (30%) did not receive any organized rehabilitation in this study.

Conclusions—Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome. Patients with moderate or severe stroke appear to benefit most.

• rehabilitation
• stroke management
• stroke outcome

Studies of services specialized in caring for patients with acute stroke show that well-organized management reduces mortality, neurological deficits, functional disability, and long-term institutional care.^{1 2 3 4 5 6 7 8 9} Still remaining unanswered are the questions of which components in the care of acute stroke patients are effective,¹ where and how rehabilitation of stroke patients in the subacute period should take place, and whether all stroke patients should be offered subacute coordinated multidisciplinary rehabilitation.¹⁰

It has been maintained that the patients most appropriate for subacute rehabilitation are those with moderately severe deficits,⁷ although one particular study⁹ showed that severely disabled patients with a poor prognosis had a better outcome when treated in a stroke rehabilitation unit. A subgroup analysis of an overview of stroke trials showed that stroke severity was not associated with the effectiveness of the treatment.¹

The resources available for long-term rehabilitation may be limited by an increasing number of stroke patients. Few randomized controlled studies exist that evaluate management of stroke patients after the acute treatment.^{2 7 11 12 13} In these studies the groups that were offered specialized subacute stroke rehabilitation had fewer deaths and better functional outcome (although not to a level of significance in each trial). One study¹³ has shown that specialist community rehabilitation after the acute treatment is clinically as effective as hospital care. The Stroke Unit Trialists’ Collaboration¹ showed that admission of stroke patients a week or more after a stroke did not eliminate the effectiveness of the stroke unit care.

It is therefore still under debate whether patients in the subacute phase should be offered rehabilitation in their local environment or in hospital-based rehabilitation units^{14 15} and which level of rehabilitation is proper for different subgroups.¹⁶ We have previously shown that treatment in an acute stroke unit with a length of stay of approximately 7 days reduces mortality¹⁷ and neurological but not functional deficits.¹⁸ We considered the length of stay in the acute stroke unit to be too short to affect functional disability.

This study was performed to assess the efficacy of a hospital-based rehabilitation program in reducing neurological impairment and functional disability and increasing health-related quality of life among patients with subacute stroke. We also wanted to determine whether severity influenced the benefit of a rehabilitation unit with a subacute rehabilitation program.