Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit

Purpose. Earlier and more intense rehabilitation benefit stroke patients. Yet, studies have caution intensive therapy during acute brain injury. This study examined the rehabilitation commencement time and intensity as predictors of functional outcomes in acute stroke patients admitted to the stroke intensive care unit (ICU). Method. Sociodemographic, medical, rehabilitative and functional data were collected on 154 acute stroke patients. Regression analyses were used to identify predictors for the basic activities of daily living (Barthel Index, BI) and the walking ability at discharge. Result. Rehabilitation commencement time and intensity significantly predicted the BI score at discharge after adjusting for initial severity (National Institute of Health Stroke Scale, NIHSS) and age (p < 0.05). For the walking function at discharge, only the rehabilitation intensity was a significant predictor after adjusting for initial severity and age (p < 0.05). Furthermore, with increasing rehabilitation intensity, patients with severe stroke benefited more than those with moderate stroke. Conclusion. Rehabilitation commencement time and intensity, after adjusting for admission functional status and severity of stroke, remained to be important predictors of stroke functional outcomes. This study supported the recommendation to commence rehabilitation early and intensively and provided evidence that this claim can be extended to acute stroke patients admitted to an ICU.

[1]  Robert Teasell,et al.  Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. , 2006, Journal of rehabilitation medicine.

[2]  J. Grotta,et al.  Early exclusive use of the affected forelimb after moderate transient focal ischemia in rats : functional and anatomic outcome. , 2000, Stroke.

[3]  A. Heinemann,et al.  Relative Importance of Rehabilitation Therapy Characteristics on Functional Outcomes for Persons With Stroke , 2004, Stroke.

[4]  T. Schallert,et al.  Use-dependent exacerbation of brain damage occurs during an early post-lesion vulnerable period , 1998, Brain Research.

[5]  Eso Writing,et al.  Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008 , 2008 .

[6]  Sung-Chun Tang,et al.  Predictors of survival and functional outcome in acute stroke patients admitted to the stroke intensive care unit , 2008, Journal of the Neurological Sciences.

[7]  F. Schmidt Meta-Analysis , 2008 .

[8]  R. Keith,et al.  Acute and subacute rehabilitation for stroke: a comparison. , 1995, Archives of Physical Medicine and Rehabilitation.

[9]  C. Hsieh,et al.  Prediction of functional outcomes in stroke inpatients receiving rehabilitation. , 2003, Journal of the Formosan Medical Association = Taiwan yi zhi.

[10]  S. Slørdahl,et al.  Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? , 1999, Stroke.

[11]  W. Koroshetz,et al.  Predictors of mortality in stroke patients admitted to an intensive care unit , 2000, Critical care medicine.

[12]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[13]  R. Boots,et al.  Outcome of Stroke Patients Admitted to Intensive Care: Experience from an Australian Teaching Hospital , 2002, Anaesthesia and intensive care.

[14]  D. Jette,et al.  The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. , 2005, Archives of physical medicine and rehabilitation.

[15]  C. Henderson,et al.  Role of WHO. , 1982, Experientia. Supplementum.

[16]  C. Granger,et al.  Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities. , 2002, Archives of physical medicine and rehabilitation.

[17]  R. Teasell,et al.  The Efficacy of Stroke Rehabilitation: A Qualitative Review , 2003, Topics in stroke rehabilitation.

[18]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[19]  W R Clarke,et al.  Baseline NIH Stroke Scale score strongly predicts outcome after stroke , 1999, Neurology.

[20]  Carlo Caltagirone,et al.  Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions. , 2003, Archives of physical medicine and rehabilitation.

[21]  A. Risedal,et al.  Early Training May Exacerbate Brain Damage after Focal Brain Ischemia in the Rat , 1999, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[22]  M. Hu,et al.  Correlation between duration of rehabilitation and functional outcome at discharge and at follow-up in stroke patients. , 2006 .

[23]  D. Wade,et al.  Physiotherapy intervention late after stroke and mobility. , 1992, BMJ.

[24]  C. Richards,et al.  Task-specific physical therapy for optimization of gait recovery in acute stroke patients. , 1993, Archives of physical medicine and rehabilitation.

[25]  R. Adams,et al.  A dose-response relationship between amount of weight-bearing exercise and walking outcome following cerebrovascular accident. , 1994, Archives of physical medicine and rehabilitation.

[26]  Pamela W Duncan,et al.  Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. , 2005, Stroke.

[27]  S. Paolucci,et al.  Functional Outcome in Stroke Inpatient Rehabilitation: Predicting No, Low and High Response Patients , 1998, Cerebrovascular Diseases.

[28]  S. H. Hayes,et al.  Early intervention care in the acute stroke patient. , 1986, Archives of physical medicine and rehabilitation.

[29]  H. Barbeau,et al.  Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. , 2003, Archives of physical medicine and rehabilitation.

[30]  LalitKalra,et al.  Role of Stroke Rehabilitation Units in Managing Severe Disability After Stroke , 1995 .

[31]  E. Troisi,et al.  Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. , 2000, Archives of physical medicine and rehabilitation.