A synthesis of studies on stroke rehabilitation.

The functional rehabilitation of stroke patients is a frequent service provided in hospitals and long care settings. Research regarding the effectiveness of therapy has been conducted infrequently and the results of studies often conflict. This article describes the results of seven studies which employed different study designs and sample populations. Three observational studies found that rehabilitation is effective while three experimental studies found no effect. One observational study not only failed to find a positive effect but also found that physical therapy was associated with shoulder-hand syndrome. The findings of these seven studies are synthesized in an attempt to resolve apparently conflicting results and arrive at conclusions which are consistent. The evidence suggests that functional gains experienced by stroke patients are primarily attributable to spontaneous recovery. Eighty percent of spontaneous recovery occurs within six months after the onset of stroke. Age does not appear to be an important factor in improvement although older patients tend to have more severe strokes. Socioeconomic status and family involvement correlate positively with improvement. Rehabilitation has a negligible effect on the functional progress of most stoke patients. However, rehabilitation may result in increased independence in the performance of activities of daily living for patients who have intermediate levels of functional ability. This gain in independence may have critical importance for the amount of nursing care required by these patients.