PPT Slide
An analysis of organized stroke units on functional outcome. Heather Daskewich
Background and Purpose: Stroke care, when organized on specialized stroke units, may be the most effective means of managing stroke survivors. The purpose of this paper is to examine the existing literature on stroke units, specifically rehabilitation interventions, to determine if they are effective in reducing stroke-related morbidity, mortality, and health care costs.
Methods: Articles were reviewed if 1) they specifically addressed the association between rehabilitation interventions and outcome after stroke and 2) they were meta-analyses or large randomized trials. Outcome was defined in a variety of ways, including functional status, living situation, morbidity, mortality, costs, length of stay, and quality of life. Literature from three sources was included. First, a focused and comprehensive review of the literature from 1950 to 1998 was published in 1999. Second, Medline searches of periodicals from 1990 to 1999 using the key words “stroke” and “functional outcome” (limited to English) and “stroke unit” were performed, along with a manual search of all references cited in the articles listed above. Third, a search of the Cochrane Library was performed using the keywords “stroke unit.”
Results: Patients treated in stroke units were more likely to survive, regain independence, and return home compared to patients treated on general medical wards. These results seem to be achieved without additional length of stay in hospital or increased rehabilitation therapy hours. Studies are lacking that include trials of stroke units in North America.
Conclusion: Organized stroke units are associated with better patient outcomes and have the potential to decrease health care costs by decreasing length of hospital stay and long term institutionalization following stroke.
Clinical Relevance: Patients are discharged with greater independence, which decreases the burden of stroke on patients, their families, and society, as well as improving the overall quality of life of stroke survivors.