The impact of inpatient and community stroke rehabilitation on health-related quality of life in New Zealand.
Stephanie G Thompson, Dhairya Thakkar, Harry McNaughton and 2 others
PMID 41159514WHAT IT FOUND
Stroke survivors who received community rehabilitation reported better quality of life at 12 months than those who did not.
Inpatient rehabilitation was linked to lower quality of life overall, likely because those patients had more severe strokes, though the most severely impaired saw benefits.
Key findings
01Patients who received community rehabilitation had significantly higher health-related quality of life scores at 12 months compared to those who did not, after adjusting for confounders.
02Patients who received inpatient rehabilitation had significantly lower case-mix-adjusted quality of life scores at both 3 and 12 months compared to those who did not receive inpatient rehab.
03When stratified by stroke severity, the most severely impaired patients who received inpatient rehabilitation had higher quality of life scores than those who did not.
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
This is an observational study, not a randomized trial, so it cannot prove that rehabilitation causes changes in quality of life. The stroke severity measure used (SSV model) may not have captured the complexity of deficits, meaning patients in inpatient rehab might have been sicker than the adjustment accounted for. The EQ-5D-3L measure has ceiling effects and may not capture subtle improvements in quality of life. The study did not control for the specific intensity or content of the rehabilitation received, only whether it was inpatient or community-based.
Declared interests
The study was funded by the Health Research Council of New Zealand. One author, Anna Ranta, received a research grant from this funder.
The easy way to misread this
Do not conclude that inpatient rehabilitation harms patients. The lower quality of life scores in this group are likely due to the fact that these patients had more severe strokes and greater disability at baseline, which the statistical adjustment may not have fully accounted for.