Stroke Rehabilitation Patients, Practice, and Outcomes: Is Earlier and More Aggressive Therapy Better?

Abstract 

Horn SD, DeJong G, Smout RJ, Gassaway J, James R, Conroy B. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?

Objective

To examine associations of patient characteristics, rehabilitation therapies, neurotropic medications, nutritional support, and timing of initiation of rehabilitation with functional outcomes and discharge destination for inpatient stroke rehabilitation patients.

Design

Prospective observational cohort study.

Setting

Five U.S. inpatient rehabilitation facilities.

Participants

Poststroke rehabilitation patients (N=830; age, >18y) with moderate or severe strokes, from the Post-Stroke Rehabilitation Outcomes Project database.

Interventions

Not applicable.

Main Outcome Measures

Discharge total, motor, and cognitive FIM scores and discharge destination.

Results

Controlling for patient differences, various activities and interventions were associated with better outcomes including earlier initiation of rehabilitation, more time spent per day in higher-level rehabilitation activities such as gait, upper-extremity control, and problem solving, use of newer psychiatric medications, and enteral feeding. Several findings part with conventional practice, such as starting gait training in the first 3 hours of physical therapy, even for low-level patients, was associated with better outcomes.

Conclusions

Specific therapy activities and interventions are associated with better outcomes. Earlier rehabilitation admission, higher-level activities early in the rehabilitation process, tube feeding, and newer medications are associated with better stroke rehabilitation outcomes.

Key Words:  Cerebrovascular accident , Outcome assessment , Rehabilitation , Severity of illness , Stroke