Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?
Horn SD, DeJong G, Smout RJ, Gassaway J, James R, Conroy B. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?


OBJECTIVE
To examine associations of patient characteristics, rehabilitation therapies, neurotropic medications, nutritional support, and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients.


METHODS
Prospective observational cohort study.


METHODS
Five U.S. inpatient rehabilitation facilities.


METHODS
Post-stroke rehabilitation patients (N=830; age, >18 y) with moderate or severe strokes, from the Post-Stroke Rehabilitation Outcomes Project database.


METHODS
Not applicable.


METHODS
Discharge total, motor, and cognitive FIM scores and discharge destination.


RESULTS
Controlling for patient differences, various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation, more time spent per day in higher-level rehabilitation activities such as gait, upper-extremity control, and problem solving, use of newer psychiatric medications, and enteral feeding. Several findings part with conventional practice, such as starting gait training in the first 3 hours of physical therapy, even for low-level patients, was associated with better outcomes.


CONCLUSIONS
Specific therapy activities and interventions are associated with better outcomes. Earlier rehabilitation admission, higher-level activities early in the rehabilitation process, tube feeding, and newer medications are associated with better stroke rehabilitation outcomes.
Horn
Susan D
SD
Institute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT 84102-1282, USA. shorn@isisicor.com
DeJong
Gerben
G
Smout
Randall J
RJ
Gassaway
Julie
J
James
Roberta
R
Conroy
Brendan
B
D000203:Activities of Daily Living; D000368:Aged; D002491:Central Nervous System Agents / Q000008:administration & dosage; D015331:Cohort Studies; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
D002491:Central Nervous System Agents