MEDICAL COMPLICATIONS DURING STROKE REHABILITATION

Background and Purpose We sought to evaluate the effect of setting on the rate of medical complications during stroke rehabilitation. Methods A study of the frequency and nature of medical complications in stroke rehabilitation was undertaken in 245 patients managed either on a stroke rehabilitation unit (n=124) or on general medical wards (n=121). The stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications leg, aspiration, infections, thromboembolism, pressure sores, depression, stroke progression). Similar protocols did not exist on general medical wards except for thromboembolism, pressure sores, and secondary stroke prevention. Results Medical complications were documented in 147 patients (60%) and were more common in patients with severe strokes (97%). The frequency of reported complications was similar in both settings. Aspiration (33% versus 20%; P<.01) and musculoskeletal pain (38% versus 23%; P<.05) were more commonly documented on the stroke unit, whereas urinary problems (18% versus 7%; P<.01) and infections (49% versus 25%; P<.01) were more commonly seen on general medical wards. The reported frequency of deep vein thrombi, pressure sores, and stroke progression was similar in both settings. Although depression was reported equally in both settings (34% on the stroke unit versus 27% on general wards), patients on the stroke unit were more likely to be treated compared with general wards (67% versus 36%; P<.05). Conclusions The study shows that inpatient stroke rehabilitation is a medically active service. Management on specialist units is associated with earlier detection and management of stroke-related problems and prevention of potentially life-threatening complications.