How much rehabilitation is enough after stroke?

BACKGROUND:

In Israel, approximately 19,000 stroke events occur annually, with 25% affecting individuals under 65 years of age. While post-stroke rehabilitation is crucial for recovery, only 30% of patients are discharged to rehabilitation hospitals. This study aimed to investigate the extent to which stroke patients regained their pre-stroke functional capacity over 12 months following the acute event.

METHODS:

This prospective cohort study recruited stroke patients from six neurological wards across Israel between December 2017 and December 2020. Functional ability was assessed using the modified Rankin Scale (mRS) at discharge and the Barthel index through telephone interviews at 4, 8, and 12 months post-hospitalization in Hebrew, Russian, or Arabic. The study evaluated the association between hospital discharge destination and functional recovery.

RESULTS:

Of 606 eligible patients (65% men, mean age 66.6 years), 463 consented to participate, with 411 completing the 4-month follow-up. By 4 months post-stroke, 63% of patients regained their pre-stroke functional level. Among those who did not recover fully by 4 months, 21.5% achieved full recovery by 12 months. Factors associated with better recovery at 4 months included younger age (OR=0.96, 95%CI 0.93-0.99), male gender (OR=2.24, 95%CI 1.21-4.23), Jewish ethnicity (OR=6.28, 95%CI 2.49-18.89), and full employment prior to stroke (OR=3.92, 95%CI 1.89-8.51). Factors associated with better recovery at follow-up were being married (OR=5.40, 95%CI 1.25-38.65) and being partially or fully employed prior to the stroke event. Patients discharged to rehabilitation hospitals initially had worse outcomes but showed greater improvement over time.

CONCLUSIONS:

The study emphasizes the importance of inpatient rehabilitation programs for improving functional outcomes in stroke patients. Results suggest that demographic and socioeconomic factors significantly influence recovery trajectories, highlighting the need for targeted rehabilitation strategies and equitable access to rehabilitation services.