Early versus delayed inpatient stroke rehabilitation: A matched comparison conducted in Italy☆☆☆

Presented in part at the 2nd World Congress on Neurorehabilitation, April 1999, Toronto, Canada, and at the 8th European Stroke Conference, April 1999, Venice, Italy.

Received 8 September 1999; received in revised form 29 October 1999; accepted 29 October 1999.

Abstract

Paolucci S, Antonucci G, Grasso MG, Morelli D, Troisi E, Coiro P, Bragoni M. Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil 2000;81:695-700. Objective: To assess the specific influence of onset–admission interval (OAI) on rehabilitation results. Design: A case-control study in consecutive stroke inpatients, enrolled in homogeneous subgroups, matched for age (within 1 year) and Barthel Index (BI) score at admission, and different for OAI to the rehabilitation ward. The short OAI group began rehabilitation treatment within the first 20 days from stroke, medium OAI group between days 21 and 40, and long OAI between days 41 and 60. Setting: Rehabilitation hospital. Patients: One hundred forty-five patients with sequelae of first stroke. Main Outcome Measures: Efficiency (average increase in BI per day), effectiveness (proportion of potential improvement achieved during rehabilitation) of treatment, and percentage of low- and high-response patients, calculated on BI, were evaluated. Odds ratios (ORs) of dropouts and of poor and excellent therapeutic response were also quantified. Results: The short OAI subgroup had significantly higher effectiveness of treatment than did the medium (p < .05) and the long OAI groups (p < .005). Beginning treatment within the first 20 days was associated with a significantly high probability of excellent therapeutic response (OR = 6.11; 95% confidence interval [CI], 2.03-18.36), and beginning later was associated with a similar risk of poor response (OR = 5.18; 95% CI, 1.07-25.00). On the other hand, early intervention was associated with a five times greater risk of dropout than that of patients with delayed start of treatment (OR = 4.99; 95% CI, 1.38-18.03). The three subgroups were significantly (p < .05) different regarding the percentage of low and high responders. Conclusion: Our results showed a strong association between OAI and functional outcome. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Keywords: Italy, Rehabilitation, Stroke, Treatment outcome

I.R.C.C.S. Santa Lucia (Paolucci, Antonucci, Grasso, Morelli, Troisi, Coiro, Bragoni), and the Department of Psychology, University of Rome (Antonucci), Rome, Italy

☆ No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

☆☆ Reprint request to Stefano Paolucci, MD, I.R.C.C.S. Santa Lucia, Via Ardeatina 306, 00179, Rome, Italy.

PII: S0003-9993(00)90095-9

doi:10.1016/S0003-9993(00)90095-9

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