Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review.
Cecilie Røe, Erik Bautz-Holter, Nada Andelic and 7 others
PMID 35756983WHAT IT FOUND
Inpatient stroke units and home-based cardiac rehab improved function more than general wards or hospital stays.
Most other setting changes showed no difference. Service organization matters, but results depend heavily on the specific condition and intervention compared.
Key findings
01Integrated stroke units produced significantly better functional outcomes (Barthel Index) than general wards in several studies.
02Home-based outreach rehabilitation resulted in significantly higher quality of life scores than hospital-based cardiac rehabilitation.
03Comparisons between outpatient, home-based, and community settings generally showed no significant differences in functional outcomes or quality of life.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The included studies varied widely in patient conditions and outcome measures, making it difficult to draw broad conclusions or combine data statistically. Many studies were conducted before 2010, so they may not reflect current rehabilitation practices or technologies. The review only included randomized controlled trials, which might miss valuable insights from observational studies on service organization. Differences in outcomes could be driven by the specific clinical interventions provided rather than just the organizational setting, as these factors often overlap and were not always separated in the original studies.
The easy way to misread this
Do not assume that moving rehabilitation services to home or community settings is universally equivalent to hospital-based care. While many studies showed no difference, specific conditions like stroke recovery clearly benefited from specialized inpatient units, and cardiac patients had better quality of life with home-based outreach. The 'setting' is not a neutral variable; its effect depends entirely on the patient's diagnosis and the specific services being compared.