Only a selected group of variables have repeatedly proven to be significant predictors of functional ability after post-stroke inpatient rehabilitation. [Box: see text].

Background: Community stroke rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to stroke rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. Methods: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. Results: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5 ± 13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p = 0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p < 0.001), Functional Independence Measure (p < 0.001), Reintegration to Normal Living Index (p = 0.01), Bakas Caregiver Outcomes Scale (p < 0.001), and Caregiver Assistance and Confidence Scale assistance subscale (p = 0.005). Significant gains were observed on the strength, communication, activities of daily living, social participation, memory, and physical domains of the Stroke Impact Scale (all p < 0.001). These improvements were maintained at the 6-month follow-up. No significant improvements were observed upon discharge on the memory and thinking domain of the Stroke Impact Scale; however, there was a significant improvement between admission and follow-up (p = 0.002). All significant improvements were maintained at the 6-month follow-up. Conclusions: Results indicate that the community stroke rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, stroke-specific multidisciplinary rehabilitation program should be considered when accessibility to outpatient services is limited.RÉSUMÉ: Équipes communautaires de réadaptation post AVC : Apport d'une réadaptation post AVC à domicile en Ontario (Canada) Contexte: Les équipes communautaires de réadaptation post AVC (CSRT) fournissent une approche interdisciplinaire ancrée dans la communauté pour la réadaptation après un AVC. Notre objectif était d'évaluer l'efficacité de ces équipes par rapport aux aboutissements de ses clients. Méthodes: Des données d'évolution fonctionnelle, psychosociale ainsi que l'opinion des aidants ont été disponibles au moment de la prise en charge et de la sortie du programme, ainsi qu'après un suivi de six mois. L'analyse de covariance des mesures répétées a été réalisée pour évaluer les changements du patient entre chaque échéance pour chacun des critères d'évaluation. Résultats: Un total de 794 clients répondait aux critères d'inclusion pour l'analyse (54,4 % d'hommes, âge moyen 68,5 ± 13,0 ans). Des modifications significatives ont été constatées entre la prise en charge et le congé pour le score total de l'échelle HAD (Hospital Anxiety and Depression) de mesure de l'anxiété et d...

The SIS performed well in a sample of patients undergoing stroke rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor rehabilitation interventions to target the dimensions of health that are most important to a patient's overall health and perceived quality of life over time. Implications for Rehabilitation There is an increased need for valid and reliable measures to evaluate the outcomes of patients recovering from stroke in the community. The Stroke Impact Scale (SIS) measures multiple domains of health and is well-suited for use in patients recovering from stroke in the community. There is a high level of internal consistency in the eight SIS domains with no evidence of floor effects; ceiling effects were noted for several domains. Correlation of the SIS with the Euroqol-5D suggested that the dimensions of health contributing to a patient's perception of health related quality of life changes over time.

Randomized controlled trials in stroke rehabilitation have increased over the past four decades, with an associated increase in methodological quality, but not sample size.

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.