A total of 79 studies investigated the association between rehabilitation interventions and functional outcomes after stroke. Of these, 38 were found to be either Level I or II evidence and therefore included in the review. The number of participants included in each study was not stated.
Eleven well-designed Level II studies looked at functional deficits as predictors of functional outcome following stroke. Overall, the available literature demonstrated that decreased functional abilities in the first 1 to 4 weeks after stroke were strongly associated with decreased discharge to home rates and functional outcome at both rehabilitation discharge and up to 6 months follow-up.
Four well designed Level II studies looked at the association of the timing of rehabilitation interventions, and outcome after stroke. Overall, the available literature demonstrated that early onset of rehabilitation interventions - within 3 to 30 days poststroke - was strongly associated was improved functional outcome.
Eleven well-designed Level I studies investigated the type of inpatient rehabilitation, interdisciplinary versus multidisciplinary, as a predictor of outcome following stroke. Overall, the available literature demonstrated that interdisciplinary versus multidisciplinary inpatient rehabilitation is strongly associated with improved functional outcome, shorter length of stay, decreased costs, and decreased mortality. Importantly, all of the available meta-analyses and Level II investigations were performed in Europe (Great Britain, Scandinavia), and thus the generalisability of these findings to non-European rehabilitation care is unknown.
Three well-designed Level II studies investigated the association between type of non-inpatient rehabilitation services, specifically day versus outpatient versus home therapy, and functional outcome after stroke. This literature did not allow clear differentiation between type of non-inpatient rehabilitation services; however, home health services may be weakly associated with improved 6-month functional outcome when compared with day rehabilitation services.
Five Level I (n=1) and Level II (n=4) studies examined the association between the specificity of rehabilitation services, in particular the types of physical, occupational, speech, and psychology therapy, and functional outcome following stroke. Overall, the available literature demonstrated that task-specific therapy services versus more generalised therapy was weakly associated with improved functional outcome after strike.
Four Level I (n=1) and II (n=3) studies examined the association between the intensity of rehabilitation services, in particular occupational, speech, and psychology therapy, and functional outcome following stroke. Overall, the available literature demonstrated that the intensity of rehabilitation services was weakly associated with improved functional outcome after stroke.