Organised inpatient (stroke unit) care for stroke

Govan, Lindsay; Langhorne, Peter; Dennis, Martin; Weir, Christopher J.; Williams, B.; Asplund, Kjell; Berman, Peter H.; Blomstrand, Christian; Britton, M; Cabral, Norberto Luiz; Cavallini, Anna; Dey, Paola; Hamrin, Elisabeth; Hankey, Graeme J.; Indredavik, Bent; Kalra, Lalit; Kaste, Markku; Laursen, Søren østergaard

doi:10.1002/14651858.cd000197.pub2

Cited by 386 publications

(98 citation statements)

References 49 publications

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“…To date, evidence supporting memory, language, and cognitive rehabilitation is limited [44]. Our propensityadjusted analyses also documented a survival advantage and greater odds of home discharge associated with comprehensive rehabilitation consistent with the European studies [3], which showed improvements in the same outcomes with more comprehensive rehabilitation services.…”

Section: Discussionsupporting

confidence: 78%

“…Potentially unmeasured confounding related to real world selection of comprehensive rehabilitation could be inflating the treatment-related outcome differences shown. Nevertheless, consistency of findings across our large observational study with the European studies [3] support the effectiveness of real-world comprehensive rehabilitation services for stroke. Because the VHA populations are primarily male and because of structural differences in the provision of rehabilitation, we cannot be certain that findings will generalize to rehabilitation services provided to the larger U.S. population.…”

Section: Discussionsupporting

confidence: 77%

“…Evidence primarily from Europe based on 41 trials involving 6,936 participants shows that interdisciplinary rehabilitation provided on an organized stroke unit compared with care on a general hospital ward leads to increased independency, less need for institutionalization, and increased survival after hospital discharge [3]. Although the benefits of comprehensive stroke unit care are clear from the European literature, the effectiveness of comprehensive services on dedicated bed sections during acute hospitalization as practiced in the United States is not well established.…”

Section: Introductionmentioning

confidence: 99%

“…Following this assessment, some patients are transferred to specialized bed services within the acute hospitalization where they receive rehabilitation on discrete units analogous in comprehensiveness to the services provided in dedicated European stroke units. Other patients remain on nonrehabilitative hospital services where they receive consultative rehabilitation services analogous to general wards in the European studies [3]. Consequently, the VHA system provides an opportunity to study the effectiveness of rehabilitation services provided in the United States that more closely mirrors the European stroke model.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

et al. 2014

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Abstract-Comprehensive rehabilitation services after acute stroke have been shown efficacious in European trials; however, their effectiveness in everyday practices in the United States is unknown. We compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services after acute stroke using propensity scores. Outcomes included change in patients' physical and cognitive independence after rehabilitation, discharge to home as opposed to other settings, and 1-yr after hospital discharge survival. Of the 2,963 patients in the study, 683 (23.1%) received comprehensive rehabilitation while the remaining patients received consultative services. We found, after propensity adjustment, that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 (95% confidence interval [CI]: 9.1 to 16.5) more points of physical independence on a 78-point scale and gained 1.5 (95% CI: 0.8 to 2.2) more points of cognitive independence on a 30-point scale. The likelihoods of discharge to home from the hospital (odds ratio [OR] = 1.61, 95% CI: 1.07 to 2.44) and 1 yr posthospital discharge survival (OR = 1.79, 95% CI: 1.25 to 2.56) were significantly higher among those who received comprehensive rehabilitation. Among patients hospitalized for acute stroke, comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1 yr survival.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

et al. 2014

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“…Son estructuras geograficamente delimitadas con monitorización continua no invasiva, con personal entrenado y coordinado por neurólogos que dirigen un equipo multidisciplinario. Han demostrado, con un nivel de evidencia I, que mejoran la morbimortalidad con un equilibrio coste/eficacia favorable, y reducen las complicaciones y la dependencia 3,4 . La Declaración de Helsinborg, un consenso paneuropeo para el manejo del ictus, recoge que las UI constituyen el cuidado mas efectivo del ictus y la intervención con mayor beneficio comunitario y superan claramente a la trombólisis.…”

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Unidades de ictus: el mejor tratamiento para los pacientes con ictus

et al. 2009

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Rural-Urban Differences in Acute Stroke Management Practices

Leira¹,

Hess²,

Torner³

et al. 2008

Arch Neurol

122

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cute stroke management practices in rural areas of the United States are suboptimal, which creates an unacceptable health disparity between urban patients with stroke and their rural counterparts. The existing gap between urban and rural stroke care may widen in the future as more urban-tested interventions are incorporated into the treatment of acute stroke. We conducted a PubMed search to identify all the articles published from 1997 to 2007 that addressed acute stroke, paramedics, ambulances, emergency services, and interhospital transportation pertaining to the US rural, urban, or nonurban environment. We review herein the problems and potential solutions that exist in 3 aspects of the current rural stroke care system: prehospital care, rural local hospital emergency department care, and interhospital transfer of patients and subsequent reception at a larger tertiary care institution, which often involve long distances and considerable time. We conclude that the current gap in rural-urban stroke management practices could be overcome with a comprehensive strategy that addresses the existing issues, including further education of rural caregivers, remote support from tertiary care institutions, and implementation of future acute clinical trials that test the rural strategies to stroke care.

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Organised inpatient (stroke unit) care for stroke

Cited by 386 publications

References 49 publications

Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

Unidades de ictus: el mejor tratamiento para los pacientes con ictus

Rural-Urban Differences in Acute Stroke Management Practices

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