Article

OBJECTIVE: To study the functional outcome of stroke rehabilitation from 2 units
that are similar in most aspects except for location: freestanding rehabilitation
units (FSRU) versus acute care hospital (acute hospital rehabilitation unit
[AHRU]). DESIGN: An observational retrospective cohort study. SETTING:
Rehabilitation units in university-affiliated hospitals in Australia. METHODS:
Five-year data on functional outcomes of stroke rehabilitation and rehabilitation
process measures from an FSRU were compared with data from the subsequent 5 years
after the same unit was relocated to an AHRU. MAIN OUTCOME MEASUREMENTS: Time
from stroke onset to rehabilitation assessment, time to transfer to
rehabilitation, length of stay (LOS), Functional Independence Measure (FIM)
score, Motor Assessment Scale (MAS) score, transfer back to acute care, walking
velocity, and discharge destination. RESULTS: Data on 357 patients from an FSRU
and 372 patients from an AHRU who completed the rehabilitation program are
presented. Baseline characteristics, such as age, gender, stroke location, stroke
type, and risk factors, were similar in the 2 groups. There was no difference in
outcomes such as FIM score, MAS score, walking velocity, or discharge
destination. On regression analysis, the patients in an FSRU had a longer LOS
(37.6 versus 35.9 days) and were more likely to be transferred to acute care than
from an AHRU (12.4% versus 5.4%). The episode LOS (total LOS in acute and
rehabilitation units) was nearly identical in the 2 settings at 52.6 days (15 in
acute care + 37.6 days in an FSRU and 16.7 in acute care + 35.9 days in an AHRU).
CONCLUSIONS: Stroke rehabilitation effectiveness is not related to the proximity
of a rehabilitation facility to acute medical services. However, the increased
need for the transfer of patients with medical complications from FSRU to acute
care, longer LOS in an FSRU, and greater difficulty in obtaining consultations
from other medical specialties persuade us to recommend a unit co-located with
acute care services instead of an FSRU.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS