Early Physical Activity and Discharge Destination after Stroke: A Comparison of Acute and Comprehensive Stroke Unit Care

Abstract

Background. Common models of acute stroke care include the acute stroke unit, focusing on acute management, and the comprehensive stroke unit, incorporating acute care and rehabilitation. We hypothesise that the rehabilitation focus in the comprehensive stroke unit promotes early physical activity and discharge directly home. Methods. We conducted a two-centre prospective observational study of patients admitted to a comprehensive or acute stroke unit within 14 days poststroke. We recruited 73 patients from each site, matched on age, stroke severity, premorbid function, and walking ability. Patient activity was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination, and length of stay were extracted from the medical record. Results. The comprehensive stroke unit group included more males, fewer partial anterior circulation infarcts, more lacunar infarcts, and more patients ambulant without aids prior to their stroke. Patients in the comprehensive stroke unit spent 14.4% more (95% CI: 8.9%–19.8%; P < 0.001) of the day in moderate or high activity, 18.5% less time physically inactive (95% CI: 5.0%–32.0%; P = 0.008), and were more likely to be discharged directly home (OR 3.7; 95% CI 1.4–9.5; P = 0.007). Conclusions. Comprehensive stroke unit care may foster early physical activity, with likely discharge directly home.

How Can You Mend a Broken Brain? - Neurorestorative Approaches to Stroke Recovery

“…Animal studies, including some of our own research [4,23,36,] have helped guide clinical studies including the recent EXPLICIT stroke trial evaluating early constraint-induced movement therapy [39], although an earlier constraint therapy study reported negative [40] outcomes. However, results may be influenced not only by timing, but also by the type and intensity of the intervention since early aphasia therapy [41] and early physical activity [42,43] are associated with better outcomes.…”

Hospital Differences in Motor Activity Early after Stroke: A Comparison of 11 Norwegian Stroke Units

“…outcome 4,5 and seems to be more important than simply the timing of first mobilization. [3][4][5][6][7] Nevertheless, previous research has shown that activity levels vary to a large extent in patients admitted to stroke units across different countries.…”

“…[3][4][5][6][7] Nevertheless, previous research has shown that activity levels vary to a large extent in patients admitted to stroke units across different countries. [8][9][10] Understanding what drives these discrepancies could help us improve stroke care and early rehabilitation.…”

“…13 Regardless of stroke unit model, it appears that patients spend most of their day alone. 4,14 Better understanding of the facilitators of activity could help improving stroke unit care.…”

The early post-stroke mobilization

“…Ранняя мобилизация, с одной стороны, может ускорить восстановление после инсульта [11] и пред-упредить целый ряд таких осложнений, как пневмо-ния, тромбоз глубоких вен голени, образование про-лежней [12] и депрессия [14]. С другой стороны, у многих пациентов в остром периоде инсульта нару-шается ауторегуляция церебральной гемодинамики и ранняя вертикализация может привести к снижению системного артериального давления и гипоперфузии головного мозга, включая область ишемической по-лутени -пенумбры, и к последующему увеличению очага ишемии [15,16].…”