Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation.
OBJECTIVE
Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay.


METHODS
An ICP for stroke rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness 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 characteristics 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 patients receiving ICP or multidisciplinary care. Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks (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 differences 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) received between the 2 groups.


CONCLUSIONS
ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit. Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care.
Guy's, King's and St Thomas' School of Medicine, King's College, London, UK.
D
D
Sulch
I
I
Perez
A
A
Melbourn
L
L
Kalra
D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000592:standards; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008329:Managed Care Programs; D015588:Observer Variation; D009788:Occupational Therapy / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods / Q000592:standards; D011788:Quality of Life; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation; D015996:Survival Rate