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

Abstract

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.

Keywords:

• Functional outcome
• rehabilitation intensity
• commencement of rehabilitation
• stroke intensive care unit

Acknowledgments

This study was supported by the Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan) (grant DOH93-HP-1114∼DOH94-HP-1114). The authors thank Yu-Jin Jan (head nurse at the Stroke Centre), Chien-Chih Li, Yin-Jen Lin and Pei-Chen Lu (research assistants), and all members of the Departments of Physical Medicine and Rehabilitation and Nursing for their generous help.