title: Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis.
abstract: OBJECTIVE
  In current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age negatively impacts the benefit obtained from high-intensity neurorehabilitation. Our objective was to test this assumption empirically in a large sample of patients with stroke.
  
  
  METHODS
  Functional recovery during 4 weeks of inpatient neurorehabilitation was assessed with the Barthel Index (BI) in 422 middle-aged (<65 years), 1399 old (65-80 years) and 473 very old (>80 years) patients with stroke. Overall functional recovery, recovery patterns and the relationship between therapy intensity and recovery were statistically compared between the three age groups.
  
  
  RESULTS
  Overall functional recovery was statistically equivalent in middle-aged, old and very old patients (average improvement in BI total score: middle-aged: 15 points; old: 15 points; very old: 14 points). A novel item-wise logistic regression analysis (see Pedersen, Severinsen & Nielsen, 2014, Neurorehabil Neural Repair) revealed that this was true for 9 of the 10 everyday functions assessed by the BI. Furthermore, functional recovery was predicted by the amount of therapy (R=0.14; p=0.0001), and age did not moderate this relationship between therapy intensity and recovery (p=0.70).
  
  
  CONCLUSIONS
  Old and even very old patients with stroke benefit from specialised inpatient neurorehabilitation and high amounts of therapy in the same degree as younger patients. Contrary to current clinical practice, old age should not be a criterion against admission to a neurorehabilitation unit following acute stroke treatment.
authors.affiliation: Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Department of Neurology, Mauritius Hospital, Meerbusch, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Roßmüller
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Unrath
authors.affiliation: Department of Neurology, Mauritius Hospital, Meerbusch, Germany.
authors.forename: Klaus-Martin
authors.initials: KM
authors.lastname: Stephan
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Bettina
authors.identifier: http://orcid.org/0000-0002-9483-385X
authors.initials: B
authors.lastname: Studer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066530:Neurological Rehabilitation; D020127:Recovery of Function; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation
keywords: CLINICAL NEUROLOGY; EVIDENCE-BASED NEUROLOGY; REHABILITATION; STROKE