European comparison of stroke rehabilitation.
BACKGROUND
Our understanding of the components of stroke rehabilitation critical to patients' outcomes is limited. Comparing practices and outcomes across countries may give clues to how to improve rehabilitation services.


METHODS
In the CERISE project (Collaborative Evaluation of Rehabilitation in Stroke across Europe), clinical and organisational aspects of stroke rehabilitation were compared among four European rehabilitation centres (United Kingdom, Belgium, Switzerland, and Germany). Main findings were summarised and interpreted.


RESULTS
Gross motor and functional recovery were significantly better in the German and Swiss centres compared to the British centre, respectively. Insights in admission criteria, patients' therapy time, content of therapy, and task characteristics of physiotherapists and occupational therapists were in line with the differences in recovery. In Germany, neurorehabilitation is more structured with clearly defined phases, each linked with specific criteria and reimbursement schemes. In Belgium, more variation exists in the rehabilitation trajectories.


CONCLUSIONS
Stroke rehabilitation services are embedded in health care systems, creating contextual constraints with various (dis)incentives. These constraints vary between countries, resulting in differences in the organisation of stroke rehabilitation. Studies on the effectiveness of stroke rehabilitation should incorporate contextual elements of the organisation of the unit.
Putman
Koen
K
Health Services Research, Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Belgium.
De Wit
Liesbet
L
D005060:Europe; D006801:Humans; D015337:Multicenter Studies as Topic; D009788:Occupational Therapy / Q000592:standards*; D017063:Outcome Assessment, Health Care; D026761:Physical Therapy Specialty / Q000592:standards*; D012047:Rehabilitation Centers / Q000592:standards*; D000071939:Stroke Rehabilitation