Role of stroke rehabilitation units in managing severe disability after stroke

Completed

Phase N/A Results

Trial Description

To test the hypothesis that stroke rehabilitation units may improve outcome in severely disabled stroke patients.

Interventions

Trial Design

Randomized, controlled trial of 71 patients.

Patient Involvement

Patients were randomized to one of two groups. One group received treatment on a stroke rehabilitation unit. The other group received treatment on a general medical unit. Patients were treated according to existing practices in both settings. In the stroke rehabilitation ward this included comprehensive assessment by members of a multidisciplinary team upon patient arrival. The stroke rehabilitation ward emphasized identifying problems affecting activities of daily living and mobility in the context of the home environment and support available. An appropriate management strategy was designed for each patient, and long-term goals as well as the time required to achieve these goals were agreed on in consultation with patients and their relatives. Patients' individualized rehabilitation program was reviewed on a daily basis. Nursing staff was trained to reinforce therapy and relatives were encouraged to be present during nursing and therapy sessions. Care on general medical wards differed significantly in that it emphasized acute rather than rehabilitation care, had deficiencies in multidisciplinary planning and goal setting, had less patient/caregiver involvement, had inadequate support and counseling facilities, and had undue nihilism about stroke outcome.

Outcomes

Type Measure Time Frame Safety Issue
Primary Data on the stroke rehabilitation unit were collected in 'real time' with a multidisciplinary, integrated data-collection system (Orpington Stroke Management System) comprising well-validated and frequently used assessments in the major domains of stroke rehabilitation.