Stroke Rehabilitation in Australia in a Freestanding Inpatient Rehabilitation Unit Compared With a Unit Located in an Acute Care Hospital

Abstract

To study the functional outcome of stroke rehabilitation from 2 units that are similar in most aspects except for location: freestanding rehabilitation units (FSRU) versus acute care hospital (acute hospital rehabilitation unit [AHRU]). An observational retrospective cohort study. Rehabilitation units in university-affiliated hospitals in Australia. Five-year data on functional outcomes of stroke rehabilitation and rehabilitation process measures from an FSRU were compared with data from the subsequent 5 years after the same unit was relocated to an AHRU. Time from stroke onset to rehabilitation assessment, time to transfer to rehabilitation, length of stay (LOS), Functional Independence Measure (FIM) score, Motor Assessment Scale (MAS) score, transfer back to acute care, walking velocity, and discharge destination. Data on 357 patients from an FSRU and 372 patients from an AHRU who completed the rehabilitation program are presented. Baseline characteristics, such as age, gender, stroke location, stroke type, and risk factors, were similar in the 2 groups. There was no difference in outcomes such as FIM score, MAS score, walking velocity, or discharge destination. On regression analysis, the patients in an FSRU had a longer LOS (37.6 versus 35.9 days) and were more likely to be transferred to acute care than from an AHRU (12.4% versus 5.4%). The episode LOS (total LOS in acute and rehabilitation units) was nearly identical in the 2 settings at 52.6 days (15 in acute care + 37.6 days in an FSRU and 16.7 in acute care + 35.9 days in an AHRU). Stroke rehabilitation effectiveness is not related to the proximity of a rehabilitation facility to acute medical services. However, the increased need for the transfer of patients with medical complications from FSRU to acute care, longer LOS in an FSRU, and greater difficulty in obtaining consultations from other medical specialties persuade us to recommend a unit co-located with acute care services instead of an FSRU.