Stroke rehabilitation in the elderly: a new patient management system

In 1988 we introduced a new system of stroke patient management based on Barthel activities of daily living (ADL) scores. Accordingly we compared the care and outcome of elderly stroke patients at Waikato Hospital in 1987, before use of Barthel ADL testing, and 1988, after implementing this patient management system. Subjects aged 60 and above in both years had similar demographic features and indices of current stroke deficit. Functional outcome was insignificantly better in 1988 than in 1987 yet length of stay fell by 27% in 1988 (p less than 0.01). Readmission rates within 30 days of discharge remained below 2% and discharge placements were equally stable. Using categorical and generalised linear models we showed that treatment group (1988 versus 1987) independently predicted length of stay but not functional outcome. Thus the additional expertise of the rehabilitation team in 1988, in part due to the use of Barthel ADL scores in patient management decisions, appears to have reduced length of stay and hastened functional recovery without greatly influencing final functional state. Subjects with Barthel score 0-1 seven days after stroke are too impaired to participate or benefit from rehabilitation whereas those with Barthel score 19-20 are generally suitable for early discharge home. Public hospitals should consider establishing a similar stroke patient management system to provide full treatment and rehabilitation to elderly stroke patients in the shortest possible time.