Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation

Background and Purpose-Integrated Care Pathway (ICP) is an organized, goal- defined, and time-managed plan that has the potential of facilitating timel y interdisciplinary coordination, improving discharge planning, and reducin g length of hospital stay. Methods-An ICP for stroke rehabilitation based on evidence of best practice , professional standards, and existing infrastructure was developed. Its ef fectiveness was tested in 152 stroke patients undergoing rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (n =76) or conventional multidisciplinary care (n=76). Results-The age, sex, premorbid functional ability, and stroke characterist ics of the 2 groups were comparable. There were no differences in mortality rates (10 [13%] versus 6 [8%]), institutionalization (10 [13%] versus 16 [ 21%]), or length of hospital stay (50+/-19 versus 45+/-23 days) between pat ients receiving ICP or multidisciplinary care. Patients receiving conventio nal multidisciplinary care improved significantly faster between 4 and 12 w eeks (median change in Barthel Activities of Daily Living Index 6 versus 2; P<0.01) and had higher Quality of Life scores at 12 weeks (65 versus 59; P =0.07) and 6 months (72 versus 63; P<0.005). There were no significant diff erences in the mean duration of physiotherapy (42.8+/-41.2 versus 39.4+/-36 .4 hours) or occupational therapy (8.5+/-7.5 versus 8.0+/-7.5 hours) receiv ed between the 2 groups. Conclusions-ICP management offered no benefit over conventional multidiscip linary care on a stroke rehabilitation unit. Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional mul tidisciplinary care.