Relationship between rehabilitation therapies and outcome of stroke patients in Israel: a preliminary study.
BACKGROUND
The relationship between the amount of rehabilitation therapy and functional outcome in stroke patients has not been established.


OBJECTIVE
To evaluate the effectiveness of inpatient rehabilitation for post-acute stroke, and examine the relationship between intensity of therapies and functional status at discharge.


METHODS
We evaluated 50 first-stroke patients, average age 63 years, in a prospective descriptive study. The impairment and Functional Independence Measurement were assessed both at admission to rehabilitation and at discharge. Patients were monitored weekly during their stay by means of discipline-specific measures of activity level. Predictor variables included intensity of physical, occupational and speech therapies; demographic characteristics; length of stay; and time since the stroke.


RESULTS
A significant reduction in impairment was observed at discharge. The predictors of gains and activity level at discharge as well as motor vs. cognitive components of the FIM were neither consistent nor did they occur in the same trend of functional improvement. Greater FIM motor level at discharge was associated with younger age, higher admission motor and cognitive level, and receipt of any speech therapy, while greater FIM cognitive level was associated with higher cognitive level at admission, shorter interval from onset to admission, and more intense occupational therapy. More intense OT was associated with greater and more cognitive improvement during the hospitalization.


CONCLUSIONS
Since the sample was relatively small and heterogenous in terms of the patients' functional abilities, the findings cannot be generalized to the whole population of stroke patients. Further efforts to identify the best timing, modalities, intensity and frequency of the various treatments are needed to improve the cost-benefit equation of rehabilitation in stroke patients.
Keren
Ofer
O
Department of Neurologic Rehabilitation, Loewenstein Hospital Rehabilitation Center, Raanana, Israel.
Motin
Marina
M
Heinemann
Allen W
AW
O'Reilly
Camille M
CM
Bode
Rita K
RK
Semik
Patrick
P
Ring
Haim
H
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function; D012044:Regression Analysis; D012046:Rehabilitation / Q000706:statistics & numerical data*; D013070:Speech Therapy / Q000706:statistics & numerical data; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome