title: Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ.
abstract: Comprehensive rehabilitation services postacute stroke have been shown efficacious in European trials; however, their effectiveness in everyday practices in the United States is unknown. We compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services postacute stroke using propensity scores. Outcomes included change in patients' physical and cognitive independence after rehabilitation, discharge to home as opposed to other settings, and 1-yr posthospital discharge survival. Of the 2,963 patients in the study, 683 (23.1%) received comprehensive rehabilitation while the remaining patients received consultative services. We found, after propensity adjustment, that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 (95% confidence interval [CI]: 9.1 to 16.5) more points of physical independence on a 78-point scale and gained 1.5 (95% CI: 0.8 to 2.2) more points of cognitive independence on a 30-point scale. The likelihoods of discharge to home from the hospital (odds ratio [OR] = 1.61, 95% CI: 1.07 to 2.44) and 1-yr posthospital discharge survival (OR = 1.79, 95% CI: 1.25 to 2.56) were significantly higher among those who received comprehensive rehabilitation. Among patients hospitalized for acute stroke, comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1-yr survival.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics and.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Diane Cowper
authors.initials: DC
authors.lastname: Ripley
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
mesh_terms: D000208:Acute Disease; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000209:etiology / Q000534:rehabilitation*; D010351:Patient Discharge; D057216:Propensity Score; D011597:Psychomotor Performance; D020127:Recovery of Function; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D015996:Survival Rate; D013997:Time Factors; D014728:Veterans
keywords: acute stroke; cognitive independence; function; home discharge; outcomes; propensity risk score; rehabilitation services; stroke; survival; veterans