Comprehensive versus consultative rehabilitation services postacutestroke: Outcomes differ

摘要

Comprehensive rehabilitation services after acutestroke have been shown efficacious in European trials; however,their effectiveness in everyday practices in the United States isunknown. We compared outcomes of veteran patients providedwith comprehensive rehabilitation with those provided with consultativerehabilitation services after acute stroke using propensityscores. Outcomes included change in patients’ physical andcognitive independence after rehabilitation, discharge to home asopposed to other settings, and 1yr after hospital discharge survival.Of the 2,963 patients in the study, 683 (23.1%) receivedcomprehensive rehabilitation while the remaining patientsreceived consultative services. We found, after propensity adjustment,that those who received comprehensive rehabilitation comparedwith consultative gained on average 12.8 (95% confidenceinterval [CI] 9.1 to 16.5) more points of physical independenceon a 78point scale and gained 1.5 (95% CI 0.8 to 2.2) morepoints of cognitive independence on a 30point scale. The likelihoodsof discharge to home from the hospital (odds ratio [OR] =1.61, 95% CI 1.07 to 2.44) and 1 yr posthospital discharge survival(OR = 1.79, 95% CI 1.25 to 2.56) were significantly higheramong those who received comprehensive rehabilitation. Amongpatients hospitalized for acute stroke, comprehensive rehabilitationservices are associated with greater recovery of physical andcognitive independence, improved home discharge likelihood,and improved 1 yr survival.