The role of standardised assessments in comparing stroke unit rehabilitation

Background: Comparisons of outcome between stroke units are important but difficult to undertake because of differences in patient composition and operational environments. This prospective study describes the use of standardised assessments to compare stroke rehabilitation units. Methods: The study was undertaken in 186 patients admitted to two stroke units (unit A: n = 110; unit B: n = 76) over 1 year. Patients were managed according to existing practices on each unit. Data were collected on the structure, process of rehabilitation and outcome on both units. Results: The age, gender, pre-morbid function and social support characteristics of patients were comparable between the two units. Data for the whole patient group did not show significant differences for mortality or institutionalisation. Median discharge Barthel Index was higher (16 vs. 14, p < 0.02) for patients managed on unit B who also showed a longer median length of stay (59 days vs. 37 days; p < 0.001). As outcome may have been influenced by the greater proportion of mild strokes on unit B (36 vs. 7%), data for the 'middle group' of patients (unit A: n = 68; unit B: n = 48) were compared. This comparison showed no significant difference in mortality (4 vs. 8%), institutionalisation (25 vs. 17%) or median discharge Barthel Index (14 vs. 15). Patients on unit B stayed significantly longer (73 vs. 37 days) even in this group. Conclusions: Non-randomised comparisons between mainstream stroke rehabilitation units are facilitated by standardised assessments and may help identify potentially effective practices suitable for further investigation. The study also highlighted the need for extreme caution in interpreting non-randomised studies, even when standardised measures are used.