OBJECTIVE: To determine whether and how patient characteristics and the time of initiation and duration of rehabilitation influence early and long-term patient outcome after cerebrovascular accident. DESIGN: A cohort study. SETTING: Twenty rehabilitation hospitals and wards located throughout Italy. PARTICIPANTS: A total of 1716 stroke patients (874 men, 842 women) consecutively admitted to Italian hospital rehabilitation centers in 1997 and 1998. Patients had moderate to severe disability (FIM instrument score, < or =90). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three negative patient outcomes were considered: death, early failure (premature, unwanted interruption of rehabilitation program; absence of any improvement at hospital discharge), and late failure in terms of severe disability (Barthel Index score, <40) or poor quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey; questionnaire score, <80) 6 months after admission. The strength of the association between the considered variables and the outcomes was calculated with the odds ratio (OR). RESULTS: The less disabled and younger patients had better survival and early and long-term outcomes. The presence of dementia and pressure ulcers on admission was associated with worse outcomes (OR for any failure or death=1.31; 95% confidence interval [CI], 1.03-1.67; OR=1.63; 95% CI, 1.12-2.37, respectively). Patients who initiated the rehabilitative procedures early (within 7d after stroke) had better long-term outcomes than did those who initiated the rehabilitation after more than 1 month (OR=2.12; 95% CI, 1.35-3.34) or from 15 to 30 days after the acute cerebrovascular event (OR=2.11; 95% CI, 1.37-3.26). CONCLUSIONS: This study's results support the idea that recovery after stroke is greatly influenced by the clinical and demographic characteristics of the patients and that early rehabilitation intervention may have a relevant role.
OBJECTIVE: To determine whether and how patient characteristics and the time of initiation and duration of rehabilitation influence early and long-term patient outcome after cerebrovascular accident. DESIGN: A cohort study. SETTING: Twenty rehabilitation hospitals and wards located throughout Italy. PARTICIPANTS: A total of 1716 strokepatients (874 men, 842 women) consecutively admitted to Italian hospital rehabilitation centers in 1997 and 1998. Patients had moderate to severe disability (FIM instrument score, < or =90). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three negative patient outcomes were considered: death, early failure (premature, unwanted interruption of rehabilitation program; absence of any improvement at hospital discharge), and late failure in terms of severe disability (Barthel Index score, <40) or poor quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey; questionnaire score, <80) 6 months after admission. The strength of the association between the considered variables and the outcomes was calculated with the odds ratio (OR). RESULTS: The less disabled and younger patients had better survival and early and long-term outcomes. The presence of dementia and pressure ulcers on admission was associated with worse outcomes (OR for any failure or death=1.31; 95% confidence interval [CI], 1.03-1.67; OR=1.63; 95% CI, 1.12-2.37, respectively). Patients who initiated the rehabilitative procedures early (within 7d after stroke) had better long-term outcomes than did those who initiated the rehabilitation after more than 1 month (OR=2.12; 95% CI, 1.35-3.34) or from 15 to 30 days after the acute cerebrovascular event (OR=2.11; 95% CI, 1.37-3.26). CONCLUSIONS: This study's results support the idea that recovery after stroke is greatly influenced by the clinical and demographic characteristics of the patients and that early rehabilitation intervention may have a relevant role.
Authors: J D Rollnik; J Adolphsen; J Bauer; M Bertram; J Brocke; C Dohmen; E Donauer; M Hartwich; M D Heidler; V Huge; S Klarmann; S Lorenzl; M Lück; M Mertl-Rötzer; T Mokrusch; D A Nowak; T Platz; L Riechmann; F Schlachetzki; A von Helden; C W Wallesch; D Zergiebel; M Pohl Journal: Nervenarzt Date: 2017-06 Impact factor: 1.214
Authors: Toby B Cumming; Leonid Churilov; Janice Collier; Geoffrey Donnan; Fiona Ellery; Helen Dewey; Peter Langhorne; Richard I Lindley; Marj Moodie; Amanda G Thrift; Julie Bernhardt Journal: Neurology Date: 2019-07-26 Impact factor: 9.910
Authors: Eva Schielke; Markus A Busch; Thomas Hildenhagen; Martin Holtkamp; Ingeborg Küchler; Lutz Harms; Florian Masuhr Journal: J Neurol Date: 2005-03-07 Impact factor: 4.849