THE PROCESS OF REHABILITATION AND DISCHARGE PLANNING IN STROKE - A CONTROLLED COMPARISON BETWEEN STROKE UNITS

Background and Purpose-Stroke units improve outcome for stroke patient s. Comparative controlled studies between stroke units are required to determine which components of stroke unit rehabilitation influence ou tcome and which may be investigated further in randomized controlled t rials. This study compares 2 stroke units with regard to the effect di fferences in practice have on functional recovery (Barthel Index score ) and discharge planning (length of stay). Methods-Stroke unit patient s with moderate disability (Barthel score of 4 to 10 at week 1) admitt ed over 18 months were studied. Barthel measurements were obtained wee kly from week 1 to discharge. Details of stroke unit function were rec orded. The core features of stroke units were in place in both units. Rehabilitation was impairment focused (theoretically driven) on one un it and disability oriented (pragmatic) on the other. Results-Numbers o f patients were comparable (85 versus 99). Median Barthel score at wee k I (6 versus 6), time to maximal Barthel score (14 versus 14 weeks), discharge Barthel score (14 versus 14), and institutionalization (32% versus 28%); were similar in both units. Median lengths of stay differ ed (68 versus 49 days; P<0.001). Conclusions-Comparisons with regard t o the rehabilitation process can be made between stroke units. Differe nces in rehabilitation process between 2 units showed no effect on the rate of functional recovery. Length of stay was significantly differe nt between units, an effect that cannot be attributed to functional re covery and therefore reflects differences in discharge planning, inclu ding postdischarge support.