The scope for rehabilitation in severely disabled stroke patients.
OBJECTIVE
To argue the case that patients who are severely disabled by stroke may benefit from rehabilitation. To identify critical areas where more research may be helpful.


METHODS
Discussion of four negative views which could be cited as drawbacks to rehabilitation in this group. These are: (1) that patients with severe stroke do not recover; (2) that they are too ill to receive rehabilitation; (3) that rehabilitation is ineffective even when possible; and (4) that even if rehabilitation is effective, it is not cost-effective.


RESULTS
There is little work in this area. There are problems with measurement of disability in this group. None of the four negative views are supported by current evidence, and what little evidence there is provides grounds for optimism that further work could be worthwhile.


CONCLUSIONS
Specific recommendations for further work include: (1) the development of better measurement scales; (2) to determine the cost of care of severely disabled stroke patients; (3) to gain a better appreciation of the value of changes in disability states; and (4) to perform an overview analysis of rehabilitation interventions examining the degree to which severity of disability affects the response to treatment.
Gladman
J R
JR
Department of Health Care of the Elderly, University Hospital, Nottingham, UK.
Sackley
C M
CM
D002561:Cerebrovascular Disorders / Q000145:classification / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D006233:Persons with Disabilities; D017048:Health Care Costs; D015276:Health Care Rationing; D006801:Humans; D018447:Medical Futility; D018579:Patient Selection; D012720:Severity of Illness Index; D016896:Treatment Outcome