Kalra L, Dale P, Crome P
Orpington Stroke Unit, Bromley Hospitals, UK.
Stroke. 1993 Oct;24(10):1462-7. doi: 10.1161/01.str.24.10.1462.
Assessment of stroke rehabilitation is complicated by the heterogeneity of patients and settings and by difficulties in disentangling effects of organization from effects of types and amounts of treatment input.
A prospective controlled study was undertaken in 245 stroke patients stratified into three groups according to prognosis and managed on a stroke rehabilitation unit (n = 124) or general medical wards (n = 121). Patients were randomly allocated to either setting 2 weeks after stroke and were comparable for baseline characteristics.
Patients on general medical wards received more physiotherapy on average (16.2 +/- 7.2 versus 14.3 +/- 3.2 hours; P < .05) but similar amounts of occupational therapy (9.3 +/- 2.8 versus 9.5 +/- 3.2 hours) compared with stroke unit patients. More time was spent on individual rehabilitation on the stroke unit compared with general wards (P < .001). Functional abilities at discharge, destination of discharge, and length of hospital stay in patients with good prognosis were comparable in both settings. Patients with poor prognosis managed on general wards showed higher mortality (P < .05) and longer hospital stay (123.2 +/- 48.2 versus 52.3 +/- 19.8 days; P < .001), but functional abilities at discharge in survivors were comparable with those of stroke unit patients. Patients with intermediate prognosis had significantly better outcome on the stroke unit, with more patients being discharged home (75% versus 52%; P < .001), shorter average length of hospital stay (48.7 +/- 17.2 versus 104.6 +/- 28.6 days; P < .001), and better functional abilities at discharge (P < .05).
Stroke units improve outcome and reduce hospital stay without increasing therapy time. Their effectiveness may be enhanced by patient selection.
患者和治疗环境的异质性，以及难以区分组织因素与治疗投入的类型和数量所产生的影响，使得中风康复评估变得复杂。
对245例中风患者进行了一项前瞻性对照研究，根据预后将患者分为三组，并分别在中风康复单元（n = 124）或普通内科病房（n = 121）接受治疗。中风后2周，患者被随机分配至相应治疗环境，且基线特征具有可比性。
与中风单元的患者相比，普通内科病房的患者平均接受了更多的物理治疗（16.2±7.2小时对14.3±3.2小时；P <.05），但职业治疗的时长相近（9.3±2.8小时对9.5±3.2小时）。与普通病房相比，中风单元将更多时间用于个体康复（P <.001）。在两种治疗环境下，预后良好的患者出院时的功能能力、出院去向以及住院时长相当。在普通病房接受治疗的预后较差的患者死亡率更高（P <.05），住院时间更长（123.2±48.2天对52.3±19.8天；P <.001），但存活患者出院时的功能能力与中风单元的患者相当。预后中等的患者在中风单元的治疗效果显著更好，更多患者出院回家（75%对52%；P <.001），平均住院时间更短（48.7±17.2天对104.6±28.6天；P <.001），出院时功能能力更好（P <.05）。
中风单元可改善治疗效果并缩短住院时间，且无需增加治疗时间。通过患者选择可提高其有效性。
