Rehabilitation of Individuals With Severe Stroke: Synthesis of Best Evidence and Challenges in Implementation
- 1 March 2012
- journal article
- review article
- Published by Taylor & Francis Ltd in Topics in Stroke Rehabilitation
- Vol. 19 (2), 122-131
- https://doi.org/10.1310/tsr1902-122
Abstract
The rehabilitation of patients who are recovering from severe stroke is associated with a substantial use of resources but limited potential for functional improvement. As a result, these individuals are not perceived as being ideal candidates for inpatient stroke rehabilitation. The objective of this review was to describe the evidence for and discuss some of the challenges of providing inpatient rehabilitation services for individuals with severe stroke. A literature search was conducted to identify relevant studies. Studies were included if (a) inpatient rehabilitation was compared to other rehabilitation settings and (b) the study population included individuals with severe stroke-related disability. Following data abstraction, the methodological quality of randomized controlled trials (RCTs) that met inclusion criteria was assessed using the PEDro scale. Fourteen studies (including 4 RCTs) met inclusion criteria. Despite making limited functional improvement, persons with severe strokes who received inpatient rehabilitation had reduced mortality, decreased lengths of hospital stay, and increased likelihood of discharge home when compared to those who received rehabilitation in other settings. Rehabilitation on specialized stroke units resulted in better outcomes than other forms of inpatient rehabilitation for this group. Inpatient rehabilitation is beneficial for individuals with severe stroke. However, for this group, it may be necessary to rethink the emphasis on functional improvement and focus more on discharge planning. These individuals may still have restricted access to rehabilitation as a result of limited resources, the perception that they have poor rehabilitation potential, limited understanding of the goals of rehabilitation for this population, and a lack of research.Keywords
This publication has 26 references indexed in Scilit:
- Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory studyBMC Health Services Research, 2006
- Poststroke RehabilitationStroke, 2006
- Stroke Rehabilitation Patients, Practice, and Outcomes: Is Earlier and More Aggressive Therapy Better?Archives of Physical Medicine and Rehabilitation, 2005
- A Rehabilitation Program for Patients Recovering from Severe StrokeCanadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2005
- Effect of Acute Stroke Unit Care Integrated With Care Continuum Versus Conventional Treatment: A Randomized 1-Year Study of Elderly PatientsStroke, 2000
- Recovery Rates after Stroke and Their Impact on Outcome PredictionNeurorehabilitation and Neural Repair, 2000
- Initial Functional Independence Measure Score and Interval Post Stroke Help Assess Outcome, Length of Hospitalization, and Quality of CareNeurorehabilitation and Neural Repair, 2000
- Who Benefits From Treatment and Rehabilitation in a Stroke Unit? : A Community-Based StudyStroke, 2000
- Severe Disability After Stroke: Outcome After Inpatient RehabilitationNeurorehabilitation and Neural Repair, 1999
- Improving stroke rehabilitation. A controlled study.Stroke, 1993