The effectiveness and costs of intensive stroke rehabilitation and improvements in patient pathway in Finland: a retrospective benchmarking controlled trial.

The study is observational, not randomised, so it cannot prove that the rehabilitation changes caused the outcome differences. The interventions were delivered as a bundle: a neurological rehabilitation ward, a home-based rehabilitation team, trained nursing staff, a regional stroke rehabilitation unit, and expanded regional coverage, so the contribution of any single component cannot be separated. For several acute-care and cost comparisons, the authors state that the common trend assumption was violated, meaning the intervention and control regions were not changing in similar ways before the reforms. The register outcomes were indirect: discharge home, institutionalization, length of stay and costs. The study did not have stroke severity, functional ability, activities in daily living, stroke disability or quality of life. Risk adjustment used age, sex and comorbidities, which the authors say may not be enough for reliable comparison in older people. The registers did not include outpatient care, and the authors say this could bias cost estimates. Other parts of Finland also developed stroke care during the same period, so some differences may not be due to the Päijät-Häme interventions. The analysis excluded people with a previous stroke within 365 days, foreign nationals or patients with incomplete identity numbers, and people already in long-term institutional care, so it applies to community-dwelling ischaemic stroke patients in the register.

The authors declare no conflicts of interest. The supplied text does not state a funding source.

Do not read this as proof that one stroke rehabilitation service, such as a home team or a rehabilitation ward, caused the improvements. The services were changed together, some trend assumptions were violated, and the outcomes are register measures such as discharge home, institutionalization and cost, not tested patient function.