Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study

I can see nothing useful coming out of this, there seems to be NO objective damage diagnosis. Without that these dose settings are meaningless.  This crapola is what you get when you have guidelines, NOT PROTOCOLS.  God, the incredible stupidity out there in the stroke medical world. 

 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke "leader" will ream me out for being truthful, I look forward to that day.

 

Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study 

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Rohan S Grimley, Ingrid CM Rosbergen, Louise Gustafsson, ...

First Published May 11, 2020 Research Article

https://doi.org/10.1177/0269215520916899

Article information

Abstract

Objective:

The aims of this study were to describe patterns and dose of rehabilitation received following stroke and to investigate their relationship with outcomes.

Design:

This was a prospective observational cohort study.

Setting:

A total of seven public hospitals and all subsequent rehabilitation services in Queensland, Australia, participated in the study.

Subjects:

Participants were consecutive patients surviving acute stroke between July 2016 and January 2017.

Methods:

We tracked rehabilitation for six months following stroke and obtained 90- to 180-day outcomes from the Australian Stroke Clinical Registry.

Measures:

Dose of rehabilitation – time in therapy by physiotherapy, occupational therapy and speech pathology; modified Rankin Scale (mRS)- premorbid, acute care discharge and 90- to 180-day follow-up.

Results:

We recruited 504 patients, of whom 337 (median age = 73 years, 41% female) received 643 episodes of rehabilitation in 83 different services. Initial rehabilitation was predominantly inpatient (260/337, 77%) versus community-based (77/337, 21%). Therapy time was greater within inpatient services (median = 29 hours) compared to community-based (6 hours) or transition care (16 hours). Median (Quartile 1, Quartile 3) six-month cumulative therapy time was 73 hours (40, 130) when rehabilitation commenced in stroke units and continued in inpatient rehabilitation units; 43 hours (23, 78) when commenced in inpatient rehabilitation units; and 5 hours (2, 9) with only community rehabilitation. In 317 of 504 (63%) with follow-up data, improvement in mRS was most likely with inpatient rehabilitation (OR = 3.6, 95% CI = 1.7–7.7), lower with community rehabilitation (OR = 1.6, 95% CI = 0.7–3.8) compared to no rehabilitation, after adjustment for baseline factors.

Conclusion:

Amount of therapy varied widely between rehabilitation pathways. Amount of therapy and chance of improvement in function were highest with inpatient rehabilitation.

Keywords Cerebrovascular disease/stroke, rehabilitation, health services research, outcomes

Introduction

Rehabilitation is recommended to maximize functional outcomes and community participation after stroke.^1–3 Dose of rehabilitation appears to have an important and strong relationship with patient outcomes, especially for improving mobility,⁴ upper and lower limb activity,⁵ activities of daily living⁶ and aphasia.⁷ Training time is also an important factor for addressing motor impairments after stroke^4,8,9 but the magnitude needed to obtain measurable benefit is substantial.⁵ Subsequently, the Australian national guidelines for stroke recommend a minimum of three hours of active therapy (occupational therapy and physiotherapy) per weekday after acute stroke.¹
Rehabilitation can be provided in multiple settings following stroke. Guidelines throughout the world recommend early commencement of rehabilitation within a stroke unit.^10–12 Comprehensive stroke units, which provide all aspects of acute and inpatient rehabilitation in stroke, are rare in Australia. Generally, Australians who require longer periods of rehabilitation following stroke are transferred from acute stroke units to dedicated inpatient rehabilitation units.¹³ Coordinated home-based multidisciplinary rehabilitation within early supported discharge services also reduces dependency and institutional care following acute stroke,¹⁴ but only 11% of Australian hospitals report access to such a service.¹³ Little is known about how much rehabilitation is currently received across the different rehabilitation service settings, particularly when delivered in the community. Given the complexity of rehabilitation options for individual patients, to obtain a comprehensive view of rehabilitation after stroke, it is necessary to track patients across multiple service providers.

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