A Comparison of Stroke Rehabilitation Practice and Outcomes Between New Zealand and United States Facilities
Abstract
McNaughton H, DeJong G, Smout RJ, Melvin JL, Brandstater M. A comparison of stroke rehabilitation practice and outcomes between New Zealand and United States facilities.
Objective
To compare stroke rehabilitation practice and outcomes between New Zealand (NZ) and the United States.
Design
Prospective observational cohort study.
Setting
Seven inpatient rehabilitation facilities (IRFs) in the United States and NZ.
Participants
Consecutive convenience sample of 1161 patients in 6 U.S. IRFs and 130 in 1 NZ IRF (age, >18y) after acute stroke.
Interventions
Not applicable.
Main Outcome Measures
Change in FIM score and discharge destination.
Results
NZ participants were older than U.S. participants (mean: 74.1y vs 66.0y, respectively; P<.001). Measures of initial stroke severity were higher for U.S. participants. Mean rehabilitation length of stay (LOS) was shorter for U.S. participants (18.6d vs 30.0d, P<.001), but physical and occupational therapy time per patient was considerably higher despite the shorter LOS. U.S. therapists were involved in more active therapies for more of the time. Outcomes were better for U.S. participants, with fewer discharged to institutional care (13.2% vs 21.5%, P=.006) and larger changes in FIM scores.
Conclusions
U.S. participants with acute stroke who were selected for rehabilitation had better outcomes than NZ participants, despite shorter stays in the rehabilitation facility. U.S. participants had more intensive input from physiotherapists and occupational therapists, which may explain some of the larger increases in FIM scores. This suggests that further studies with tighter controls on case mix may add additional information on the effects of therapy intensity on patients with stroke.
dDepartment of Rehabilitation Medicine, Georgetown University, Washington, DC
eInstitute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT
fDepartment of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA
gDepartment of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine, Loma Linda, CA
Reprint requests to Harry McNaughton, PhD, Medical Research Institute of New Zealand, PO Box 10055, Wellington, New Zealand
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133B990005) and the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032). The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.
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 author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT