Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions.

OBJECTIVE: To determine whether and how patient characteristics and the time of initiation and duration of rehabilitation influence early and long-term patient outcome after cerebrovascular accident. DESIGN: A cohort study. SETTING: Twenty rehabilitation hospitals and wards located throughout Italy. PARTICIPANTS: A total of 1716 stroke patients (874 men, 842 women) consecutively admitted to Italian hospital rehabilitation centers in 1997 and 1998. Patients had moderate to severe disability (FIM instrument score, < or =90). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three negative patient outcomes were considered: death, early failure (premature, unwanted interruption of rehabilitation program; absence of any improvement at hospital discharge), and late failure in terms of severe disability (Barthel Index score, <40) or poor quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey; questionnaire score, <80) 6 months after admission. The strength of the association between the considered variables and the outcomes was calculated with the odds ratio (OR). RESULTS: The less disabled and younger patients had better survival and early and long-term outcomes. The presence of dementia and pressure ulcers on admission was associated with worse outcomes (OR for any failure or death=1.31; 95% confidence interval [CI], 1.03-1.67; OR=1.63; 95% CI, 1.12-2.37, respectively). Patients who initiated the rehabilitative procedures early (within 7d after stroke) had better long-term outcomes than did those who initiated the rehabilitation after more than 1 month (OR=2.12; 95% CI, 1.35-3.34) or from 15 to 30 days after the acute cerebrovascular event (OR=2.11; 95% CI, 1.37-3.26). CONCLUSIONS: This study's results support the idea that recovery after stroke is greatly influenced by the clinical and demographic characteristics of the patients and that early rehabilitation intervention may have a relevant role.