Motor and functional recovery after stroke: a comparison of 4 European rehabilitation centers.
OBJECTIVE
Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers.


METHODS
Consecutive stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing.


RESULTS
Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center (DeltaOR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center (DeltaOR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center (DeltaOR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers.


CONCLUSIONS
Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.
De Wit
Liesbet
L
Katholieke Universiteit Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101, Heverlee, Belgium. Liesbet.Dewit@faber.kuleuven.be
Putman
Koen
K
Schuback
Birgit
B
Komárek
Arnost
A
Angst
Felix
F
Baert
Ilse
I
Berman
Peter
P
Bogaerts
Kris
K
Brinkmann
Nadine
N
Connell
Louise
L
Dejaeger
Eddy
E
Feys
Hilde
H
Jenni
Walter
W
Kaske
Christiane
C
Lesaffre
Emmanuel
E
Leys
Mark
M
Lincoln
Nadina
N
Louckx
Fred
F
Schupp
Wilfried
W
Smith
Bozena
B
De Weerdt
Willy
W
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012047:Rehabilitation Centers; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome