Does the organization of postacute stroke care really matter?

Background and Purpose-Postacute rehabilitation stroke services represent a large component of stroke care. In the United States and elsewhere, major changes in the organization and funding of these services are limiting pati ent access to organized inpatient multidisciplinary care. We conducted a sy stematic review to evaluate the effectiveness of such services. Summary of Review-We defined our intervention as organized inpatient multid isciplinary rehabilitation commencing at least 1 week after stroke and soug ht randomized trials that compared this model of care with an alternative. The analysis was stratified by the particular service characteristics. We i dentified a heterogeneous group of 9 trials (6 of stroke rehabilitation uni ts; 3 of general rehabilitation wards) recruiting 1437 patients. Organized inpatient multidisciplinary rehabilitation was associated with a reduced od ds of death (odds ratio, 0.66 95% CI, 0.49 to 0.88; P<0.01), death or insti tutionalization (odds ratio, 0.70; 95% CI, 0.56 to 0.88; P<0.001), and deat h or dependency (odds ratio, 0.65; 95% CI, 0.50 to 0.85; P<0.001), which wa s consistent across a variety of trial subgroups. For every 100 patients re ceiving organized inpatient multidisciplinary rehabilitation, an extra 5 re turned home in an independent state. Conclusions-The results indicate that there can be substantial benefit from organized inpatient multidisciplinary rehabilitation in the postacute peri od, which is both statistically significant and clinically important.