Stroke: Does rehabilitation affect outcome?

A sample of 114 consecutive stroke admissions to a rehabilitation center was studied statistically to determine functional gains achieved and retained after rehabilitation. In order to provide a measure of function, a functional profile was developed that evaluates seven activities, each according to a five-point scale. It was found that significant gains were achieved which could not be attributed merely to spontaneous recovery. An estimate of the cost benefit ratio showed that the reduced cost resulting from returning patients to the family or to independent living more than paid for the cost of providing rehabilitation services to the whole sample.

Stroke rehabilitation: Outcome and prediction.

Predictors of functional outcome were developed in a group of 114 stroke patients consecutively admitted to a tertiary rehabilitation center. These predictors included a pool of medical data, the age of the patient, psychological tests and the patient's educational level. None of these predictor items showed a correlation with outcome high enough to allow precise prediction of individual outcome. They did, however, provide general indicators for those patients with severe functional impairment who are more likely to gain from a rehabilitation program. The group of medical predictors indicated that a patient with a more extensive, severe lesion, with signs of congestive heart failure, generalized arteriosclerosis, gross perceptual deficit, a lower level of education, and who is older, is less likely to improve in the rehabilitation program. Since a prediction on an individual basis was not possible, it was concluded that even the most severely involved patient should be provided with a therapeutic rehabilitation trial. There was no correlation between severity of the functional impairment at admission and the gains obtained in the rehabilitation program. The same predictors were used to predict whether the patient went home or to an institution. It was found that family income and involvement in support of the patient predicted this outcome, whereas medical data did not. Since family involvement can sometimes be changed by a therapeutic team, this predictor may also present a major target for therapeutic intervention.