title: Stroke rehabilitation in Australia in a freestanding inpatient rehabilitation unit compared with a unit located in an acute care hospital.
abstract: OBJECTIVE
  To study the functional outcome of stroke rehabilitation from 2 units that are similar in most aspects except for location: freestanding rehabilitation units (FSRU) versus acute care hospital (acute hospital rehabilitation unit [AHRU]).
  
  
  METHODS
  An observational retrospective cohort study.
  
  
  METHODS
  Rehabilitation units in university-affiliated hospitals in Australia.
  
  
  METHODS
  Five-year data on functional outcomes of stroke rehabilitation and rehabilitation process measures from an FSRU were compared with data from the subsequent 5 years after the same unit was relocated to an AHRU.
  
  
  METHODS
  Time from stroke onset to rehabilitation assessment, time to transfer to rehabilitation, length of stay (LOS), Functional Independence Measure (FIM) score, Motor Assessment Scale (MAS) score, transfer back to acute care, walking velocity, and discharge destination.
  
  
  RESULTS
  Data on 357 patients from an FSRU and 372 patients from an AHRU who completed the rehabilitation program are presented. Baseline characteristics, such as age, gender, stroke location, stroke type, and risk factors, were similar in the 2 groups. There was no difference in outcomes such as FIM score, MAS score, walking velocity, or discharge destination. On regression analysis, the patients in an FSRU had a longer LOS (37.6 versus 35.9 days) and were more likely to be transferred to acute care than from an AHRU (12.4% versus 5.4%). The episode LOS (total LOS in acute and rehabilitation units) was nearly identical in the 2 settings at 52.6 days (15 in acute care + 37.6 days in an FSRU and 16.7 in acute care + 35.9 days in an AHRU).
  
  
  CONCLUSIONS
  Stroke rehabilitation effectiveness is not related to the proximity of a rehabilitation facility to acute medical services. However, the increased need for the transfer of patients with medical complications from FSRU to acute care, longer LOS in an FSRU, and greater difficulty in obtaining consultations from other medical specialties persuade us to recommend a unit co-located with acute care services instead of an FSRU.
authors.affiliation: Department of Rehabilitation Medicine, Prince of Wales Hospital and School of Public Health and Community Medicine, University of New South Wales, High Street, Randwick, NSW 2031, Australia. p.katrak@unsw.edu.au
authors.forename: Pesi H
authors.initials: PH
authors.lastname: Katrak
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Victoria
authors.initials: V
authors.lastname: Peeva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006305:Health Status Indicators; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000458:organization & administration; D012189:Retrospective Studies; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome