The disability oriented rehabilitation unit--a major factor influencing stroke outcome.

Abstract

SUMMARY Many investigators have analyzed the effectiveness of the cardiac care unit (as a model of a disability oriented, specially staffed, geographically isolated unit) in altering outcome following acute myocardial infarction. Little data are available, however, on the efficacy of caring for patients with stroke on specially staffed disability oriented units. Of 667 patients with stroke recently discharged from the Burke Rehabilitation Center, 589 were admitted to the stroke unit (SU group) and 78 were admitted to other units (NSU group). Statistical analysis showed that the SU patients were significantly weaker, had longer onset-admission intervals, and exhibited more concurrent medical problems and neurologic deficits. There were no statistically significant intergroup differences in age, sex, and distribution of weakness. Both groups had similar treatment programs provided by staff who had rotated through the stroke unit. Ability to perform activities of daily living (dressing, feeding, hygiene, bowel and bladder routines) and length of hospitalization were similar for both groups. SU patients walked better and went home more frequently than NSU patients. These data indicate that even in a rehabilitation center specializing in treating functional disabilities, patients with stroke are more likely to improve if placed on a disability oriented unit than if they are admitted to mixed disability units which are scattered throughout the hospital.

A review of stroke rehabilitation and physiotherapy.

“…The first such study 9 reported no benefit for mildly and severely affected patients but a significantly better outcome for patients with moderate disabilities. Feigenson and colleagues 10 showed in a similar trial that patients admitted to a stroke unit were more likely to be discharged home and were able to walk better.…”

“…10 Moreover, selection criteria for patient admittance are not uniform, and duration, type, and onset of rehabilitation differ. Finally, measurements of outcome are not constant.…”

Stroke rehabilitation units: concepts, evaluation, and unresolved issues.

“…Feigensen, Gitlow and Greenberg compared 589 patients treated in a disability-orientated stroke unit with only 78 patients admitted to other units of the same rehabilitation centre. 25 Both groups had similar treatment programmes provided by staff who had rotated through the Stroke Unit. They concluded that even in a rehabilitation centre specialising in treating functional disabilities, patients with stroke are more likely to improve if placed in a disability-orientated unit than if they are admitted to mixed disability units which are scattered throughout the hospital.…”

Stroke rehabilitation: effectiveness, benefits, and cost. Some practical considerations.

“…The data showed that although the SU group had more concurrent medical problems and more severe neurological and functional deficits, they were more likely to go home after treatment and walked better at the time of discharge. 20 LOS was similar for both groups. Substantial improvement in outcome thus may be realized by regionalizing care into disability-oriented units, not only in acute care hospitals, but also in rehabilitation facilities.…”