Rehabilitation after acute stroke varies widely in terms of setting and therapy dose

Abstract

Background: National Guidelines recommend that stroke survivors should receive rehabilitation to maximize participation in the community.

Aim: To describe patterns of rehabilitation received following acute stroke in terms of dose, length of stay (LOS) and settings.

Methods: Prospective multi-centre observational study of consecutive patients surviving acute stroke. We collected minutes of rehabilitation received and LOS for all rehabilitation episodes up to 6-months post stroke in Inpatient Rehabilitation (IR), Community Rehabilitation (CR) and Transition Care (TC). IR included: Acute Stroke Units (ASU), specialized rehabilitation units (IRU) and Geriatric Evaluation Management (GEM). CR included centre and home based teams and individual outpatient rehabilitation providers. TC included residential and home-based rehabilitation.

Results: 368 patients (**% female, median age 71) received rehabilitation. A total of 721 rehabilitation episodes (mean 1.2/patient, range 1–6) were delivered at 83 services sites (29 IR, 31 CR, 9 TC, 14other). 73% of initial rehabilitation occurred in IR (70% in ASU, 24% in IRU and 6% GEM), 21% in CR and 5% through TC. Patients received a median total of 34 hours (IQR 9, 82) therapy (13 ASU, 45 IRU, 4 CR, 16 TC) over median 54 days (IQR 21, 108). Median LOS by site was ASU 9days, IRU 29days, CR 38days, TC 59days. Proportion of total episodes delivered were: ASU 27%, IRU 24%, CR 28%, TC 10%.

Of **number initial ASU rehab episodes, 53% subsequently received IR in IRU, 17% CR, 15% TC. **% of rehab days and **% of rehab dose occurred in IRU,

Initial ASU IR was associated with **total LOS, **total dose, **chance of subsequent OR/IR.

**% of all patients (*% of those receiving rehab) received <14/30 days of rehab.

Total % of episodes by service type

Conclusion: The majority of patients commenced rehabilitation within an ASU, but received the greatest total dose in IRU. CR provides greatest number of episodes, but at extremely low dose.