Acute stroke patients: Long-term effects of rehabilitation and maintenance of gains

The efficacy of rehabilitation programs to facilitate recovery after acute stroke remains controversial. To further evaluate this issue, the records of 139 "middle-band" stroke survivors were reviewed retrospectively at admission to, discharge from, and one-year follow-up from inpatient rehabilitation. Patients were divided into two groups (out-patient [ O P] or no O P) based on their involvement in physical and occupational therapy services. A repeated measures ANOVA indicated that both groups made clinically and statistically significant improvements in all functional indices between stroke onset, discharge from inpatient rehabilitation, and follow-up: O P therapy: mobility F(1,46) = 1651, p<.0001; self-care F(1,47) = 1062, p<.0001; total F (1,47) = 1093, p<.0001; no O P therapy: mobility F(91,88) = 5643, p<.0001; self-care F(1,88) = 5722, p<.0001; total F(1,88) = 6733, p<.0001. Pairwise comparisons for all functional indices revealed that all statistically significant changes in function in the no O P therapy group occurred between stroke onset and discharge: self-care (p<.0001), mobility (p<.0001), and total (p<.0001). Pairwise comparisons of all indices in the O P therapy group revealed that all differences between stroke onset and discharge functional scores were at the p<.0001 level, and score differences between discharge from inpatient rehabilitation and follow-up were as follows: self-care (p<.05), mobility (p<.001), and total (p<.005). Receipt of O P therapy services was associated with a complete upper or lower extremity hemiplegia, unilateral neglect, impaired joint-position sense, or urinary incontinence. This study demonstrates that for a "middle band" of acute stroke patients, inpatient rehabilitation appears to be effective and that most patients maintain gains achieved during inpatient rehabilitation through one-year follow-up.