OUTCOME OF SUBACUTE STROKE REHABILITATION - A RANDOMIZED CONTROLLED TRIAL

Background and Purpose-Organized acute stroke treatment reduces mortal ity, functional deficits, and the need of institutionalization after s troke. It is largely unknown whether the effects of treatment are due to early or subacute efforts. The aim of this randomized, controlled s tudy 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 qualit y of life. Methods-251 patients initially treated in the hospital were randomized to subacute rehabilitation in a hospital rehabilitation un it (n=127) or to the health services in the municipality (n=124) and w ere followed up for 7 months. Results-The combined outcome of patients ;being dead or dependent (Barthel Index score of <75) was 23% in the h ospital group and 38% in the municipality group (P=.01). Seven-month s urvival rates were 90.6% and 83.9% (P=.11), respectively. Dependency i n 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 be fore rehabilitation had significantly better outcome in the hospital r ehabilitation unit, with fewer patients becoming dependent (P=.005) an d patients having higher Scandinavian Stroke Scale (P=.026) and BI sco res (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-S ubacute rehabilitation of stroke patients in a hospital-based rehabili tation unit improves outcome. Patients with moderate or severe stroke appear to benefit most.