London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 789 837 Rehabilitation and reorganisation after stroke Determinants of neurological functional recovery potential after stroke in young adults. A. Croquelois1, A. Renggli2, D. Haselbach3 Lausanne University Hospital and University of Lausanne, Lausanne, SWITZERLAND1, Lausanne University Hospital and University of Lausanne, Lausanne, SWITZERLAND2, Lausanne University Hospital and University of Lausanne, Lausanne, SWITZERLAND3 Background and Purpose: Despite recent progress in stroke prevention and acute treatment, neu-rorehabilitation remains one of the main stems of stroke patients’ management. The aim of this study is to point out some important predicting factors of in-hospital neurorehabilitation outcomes. Material and Methods: A rehabilitation registry was created containing all patients who underwent a standardized program of neurorehabilitation in the Lausanne University hospital neurorehabilitation center after a first ever non traumatic stroke from 2005 to 2010. Predicting factors were compared to the exit Functional Independence Measure (FIM) score for each patient, using logistical regression models. Results: Age >55 years, gender, aphasia, hemilateral spatial neglect, spasticity, complica-tions, length of stay>70, Entry FIM>100 and relative possible FIM gain/week >10% come out as significant and independent predicting factors of neurorehabilitation outcome. Discussion and con-clusion: Some factors of the in-hospital rehabilitation period have been identified before (spasticity, complications, length of stay, relative possible FIM gain/week) and should be taken into account for a better management of the patients neurorehabilitation and eventually lead to a personalized reha-bilitation strategy for each patient regarding his personal needs. The question of resource allocation can also be guided by the present findings. 838 Rehabilitation and reorganisation after stroke Patients managed in a comprehensive stroke unit are more likely to be active and be dis-charged directly to home than patients managed in an acute stroke unit J. Bernhardt1, T. West2, L. Churilov3 Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA1, Royal Perth Hospital, Perth, AUSTRALIA2, Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA3 Background: Common models for stroke care include the acute stroke unit (ASU) and the compre-hensive stroke unit (CSU). The superiority of one model over another is uncertain. Our recent re-view identified greater emphasis on early multidisciplinary rehabilitation in a CSU compared to an ASU. We hypothesise that the rehabilitation focus in a CSU helps promote increased early physical activity and improves the likelihood of discharge directly home compared to ASU care. Methods: We conducted a two-centre observational study of 73 patients (< 14-days post-stroke) ad-mitted to a CSU with early rehabilitation and 73 matched patients (age, stroke severity, pre-morbid function and walking ability) admitted to an ASU with little or no rehabilitation. Patient activity from 0800-1700hrs was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination and length of stay was extracted from the medical record. Results: Multivariate median regression analyses, adjusted for age, gender, stroke severity, days post-stroke and pre-morbid function, found CSU patients spent 14.4% more (95% CI: 8.9%-19.8%; p<0.001) of the day in moderate or high activity and 18.5% less time in no physical activity (95% CI: 5.0%-32.0%; p=0.008) compared to ASU patients. CSU patients received more therapy (median: 60 mins CSU, 5 mins ASU; p<0.001) and were mobilised earlier (median: 32 hours CSU, 51 hours ASU; p=0.015). Median length of stay in the ASU was 13 days (IQR 8.0-19.5) compared to 14 days (IQR 9.5-19.5) in the CSU. After again adjusting for important factors, CSU patients were more likely to be discharged directly home (OR 3.7; 95% CI 1.4-9.5; p=0.007). Conclusion: Stroke care varies around the world and few standards exist. CSU care fosters early physical activity, with discharge directly home likely and similar length of stay. Further head to head studies may help clarify the key components of effective stroke care.
Karger_ESC London_2013
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