Journal of Rehabilitation Research & Development (JRRD)

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Volume 51 Number 7, 2014
   Pages 1143 — 1154

Abstract — Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

Margaret G. Stineman, MD;1–2 Dawei Xie, PhD;1 Jibby E. Kurichi, MPH;1* Pui L. Kwong, MPH;1 W. Bruce Vogel, PhD;3 Diane Cowper Ripley, PhD;3 Barbara E. Bates, MD4

1Center for Clinical Epidemiology and Biostatistics and 2Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA; 3Center of Innovation on Disability and Rehabilitation Research, Malcom Randall Department of Veterans Affairs Medical Center (VAMC), Gainesville, FL; and Department of Health Outcomes and Policy, University of Florida, Gainesville, FL; 4Samuel S. Stratton VAMC, Albany, NY; and Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY

Abstract — Comprehensive rehabilitation services after acute stroke have been shown efficacious in European trials; however, their effectiveness in everyday practices in the United States is unknown. We compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services after acute stroke using propensity scores. Outcomes included change in patients’ physical and cognitive independence after rehabilitation, discharge to home as opposed to other settings, and 1-yr after hospital discharge survival. Of the 2,963 patients in the study, 683 (23.1%) received comprehensive rehabilitation while the remaining patients received consultative services. We found, after propensity adjustment, that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 (95% confidence interval [CI]: 9.1 to 16.5) more points of physical independence on a 78-point scale and gained 1.5 (95% CI: 0.8 to 2.2) more points of cognitive independence on a 30-point scale. The likelihoods of discharge to home from the hospital (odds ratio [OR] = 1.61, 95% CI: 1.07 to 2.44) and 1 yr posthospital discharge survival (OR = 1.79, 95% CI: 1.25 to 2.56) were significantly higher among those who received comprehensive rehabilitation. Among patients hospitalized for acute stroke, comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1 yr survival.

Key words: acute stroke, cognitive independence, function, home discharge, outcomes, propensity risk score, rehabilitation services, stroke, survival, veterans.


View HTML ¦ View PDF ¦ Contents Vol. 51, No.7

This article and any supplementary material should be cited as follows:
Stineman MG, Xei D, Kurichi JE, Kwong PL, Vogel WB, Cowper Ripley D, Bates BE. Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ. J Rehabil Res Dev. 2014;51(7):1143–54.
http://dx.doi.org/10.1682/JRRD.2014.03.0084
ResearcherID/ORCID: Jibby E. Kurichi, MPH: 0000-0001-8694-355X; Barbara E. Bates, MD: 0000-0001-8077-2745
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