Fifty stroke patients who had already regained basic ADL-functions were investigated at the beginning and end of either inpatient or outpatient rehabilitation of similar therapeutic intensity in the same institution. For geographic reasons, outpatient treatment could only be offered to a subgroup of patients. Neurological deficits, extended ADL-functions and quality of life (SF-36) were assessed. Patients who chose outpatient rehabilitation exhibited milder neurological deficits and better ADL-function at onset. On average, outpatient rehabilitation took about 8 days more than inpatient treatment. Under rehabilitation, gains with respect to ADL-functions and the QoL-dimensions "physical role function" and "physical functional ability" were realized. The magnitude of changes did not depend on setting. A decrease in "general health perception" may be related to the inpatient treatment of patients who would have preferred an outpatient setting. Brief periods between stroke and onset of rehabilitation and longer duration of rehabilitation treatment were significantly associated with better outcome with respect to ADL-functions.

Setting preferences and expectations before and appraisals and criticisms after neurological rehabilitation of stroke patients who fulfilled German phase-D criteria (cooperative and independent in basic ADL-functions) were longitudinally assessed in a rehabilitation centre with in-patient and out-patient facilities of comparable therapeutic quality and intensities, and followed-up for 6 months. 53 patients fulfilled inclusion criteria, of whom 16 opted for and received out-patient rehabilitation, 21 opted for out-patient rehabilitation but had to receive in-patient treatment mainly for geographical reasons, and 16 preferred and received in-patient rehabilitation. Setting preferences and setting assignment did not influence patients' expectations. When assessed at discharge and after 6 months, a considerable number of patients expressed changes in setting preferences and altered reasons for setting choice. At rehabilitation onset, patients were generally optimistic that rehabilitation would lead to an improvement of functional abilities and health status. This optimism was not fulfilled, although patients improved in functional independence/activities of daily life and physical dimensions of quality of life. The subjective realization of expectations was neither associated with setting preference nor with realized setting. Improvements of functional disabilities and independence were not correlated with rehabilitation satisfaction. Patients were less disappointed with rehabilitation outcome the more they improved in dimensions of quality of life (or vice versa). The fact that setting preferences are indifferent and not stable over time indicates deficits of information and decision capacity in rehabilitation patients after stroke and may be explained by characteristics of this disease and a specific, short time-limit for decision-making. For the evaluation of rehabilitation programmes, it can also be concluded that multidimensional assessments such as the SF-36 cannot be replaced by patient satisfaction scores.

In a prospective longitudinal study, stroke patients with largely intact ADL-functions who were treated in a rehabilitation center were assessed at the beginning and end of rehabilitation treatment and 6 months afterwards. They were treated as outpatients, if they expressed a preference for this setting and if outpatient rehabilitation was logistically and geographically possible, otherwise as inpatients. We found medium- to large-size gains for physical and ADL function and associated quality-of-life dimensions (WHOQOL-BREF, SF-36). However, there were also losses in other aspects of quality of life, e. g. in the social domain. There were no differences with respect to type of setting. Patients' setting preferences influenced the development of perception of own health. There was only a small and insignificant influence of satisfaction with rehabilitation treatment. We propose an expansion of neurological outpatient rehabilitation services and a focus on factors outside the rehabilitation system that influence quality of life.