Relative Importance of Rehabilitation Therapy Characteristics on Functional Outcomes for Persons With Stroke

Abstract

Background and Purpose-The purpose of this study was to evaluate the relative importance of therapy focus, intensity, and length of stay on greater than expected functional gain, controlling for stroke severity. Methods-This observational study included 198 first-stroke patients who were recruited from 8 in-patient rehabilitation facilities and 5 subacute programs. Stroke severity (motor, sensory and cognitive impairment) at admission was measured using an instrument combining all 3 aspects; self-care, mobility, and cognitive status at admission and discharge were measured with the Functional Independence Measure. Time spent by physical, occupational, and speech-language therapists on function-and impairment-focused activities were used to compute therapy intensity by discipline and type of activity. Residual change scores, estimated by regressing discharge on admission functional status, were modeled using patient and therapy characteristics. Results-Controlling for the stroke severity, greater than expected gains in self-care were predicted by longer lengths of stay and more intensive function-focused occupational therapy, and greater than expected cognitive gains were predicted by longer stays alone. Predictors of residual change in mobility, however, differed by gender: greater than expected gains in mobility for men were predicted by longer lengths of stay and more intense function-focused physical therapy whereas, for women, they were predicted by stroke severity alone. Conclusions-Unlike previous studies using raw functional gains, therapies accounted for a significant proportion of the variance in residual functional change. The results support studies suggesting that both content and amount of therapy are important aspects.

MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study

“…Robotic therapy also increased the rate of recovery compared with conventional treatment, and gains exceeded that which was expected because of spontaneous recovery. These results, coupled with the evidence that higher intensities of conventional therapy produces greater reductions in impairment and disability [35][36][37][38][39][40][41][42], support the use of robots to increase the amount of effective therapy for stroke survivors. One should note that all the chronic subjects and most of the subacute subjects had stopped all formal one-on-one therapy from physical or occupational therapists.…”

Susceptibility to Deterioration of Mobility Long-Term After Stroke

“…Previously published studies suggest that mobility-related outcome improves after rehabilitation treatment. [1][2][3][4] However, it remains unclear whether improvements made during rehabilitation can be sustained long term after stroke. 5,6 The general view is that little recovery is to be expected Ͼ6 months after stroke.…”

Length of Stay, Discharge Destination, and Functional Improvement

“…9 This is supported by the finding that patients in class 208 were more than twice as likely to improve in FIM score than patients in class 207. Second, patients in class 207 were more often discharged into care, a decision that may be made early in rehabilitation, especially if the patient lives alone before stroke.…”

“…Currently, although used administratively, AN-SNAP is not used in Queensland as a casemix tool for funding and there are no financial penalties for long LOS. In measuring functional change, we chose SEM to compensate for error and regression to the mean; 9 we acknowledge there are other ways of measuring change. Finally, intensity of rehabilitation, although standard across the 3 units, was not measured and may have influenced the outcomes.…”