A comparison of stroke rehabilitation practice and outcomes between New Zealand and United States facilities.
McNaughton H, DeJong G, Smout RJ, Melvin JL, Brandstater M. A comparison of stroke rehabilitation practice and outcomes between New Zealand and United States facilities.


OBJECTIVE
To compare stroke rehabilitation practice and outcomes between New Zealand (NZ) and the United States.


METHODS
Prospective observational cohort study.


METHODS
Seven inpatient rehabilitation facilities (IRFs) in the United States and NZ.


METHODS
Consecutive convenience sample of 1161 patients in 6 U.S. IRFs and 130 in 1 NZ IRF (age, >18 y) after acute stroke.


METHODS
Not applicable.


METHODS
Change in FIM score and discharge destination.


RESULTS
NZ participants were older than U.S. participants (mean: 74.1 y vs 66.0 y, respectively; P<.001). Measures of initial stroke severity were higher for U.S. participants. Mean rehabilitation length of stay (LOS) was shorter for U.S. participants (18.6d vs 30.0 d, P<.001), but physical and occupational therapy time per patient was considerably higher despite the shorter LOS. U.S. therapists were involved in more active therapies for more of the time. Outcomes were better for U.S. participants, with fewer discharged to institutional care (13.2% vs 21.5%, P=.006) and larger changes in FIM scores.


CONCLUSIONS
U.S. participants with acute stroke who were selected for rehabilitation had better outcomes than NZ participants, despite shorter stays in the rehabilitation facility. U.S. participants had more intensive input from physiotherapists and occupational therapists, which may explain some of the larger increases in FIM scores. This suggests that further studies with tighter controls on case mix may add additional information on the effects of therapy intensity on patients with stroke.
McNaughton
Harry
H
Stroke/Rehabilitation Research, Medical Research Institute of New Zealand, Wellington, New Zealand. harry.mcnaughton@mrinz.ac.nz
DeJong
Gerben
G
Smout
Randall J
RJ
Melvin
John L
JL
Brandstater
Murray
M
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology