%0 Journal Article
%T Early Physical Activity and Discharge Destination after Stroke: A Comparison of Acute and Comprehensive Stroke Unit Care
%A Tanya West
%A Leonid Churilov
%A Julie Bernhardt
%J Rehabilitation Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/498014
%X Background. Common models of acute stroke care include the acute stroke unit, focusing on acute management, and the comprehensive stroke unit, incorporating acute care and rehabilitation. We hypothesise that the rehabilitation focus in the comprehensive stroke unit promotes early physical activity and discharge directly home. Methods. We conducted a two-centre prospective observational study of patients admitted to a comprehensive or acute stroke unit within 14 days poststroke. We recruited 73 patients from each site, matched on age, stroke severity, premorbid function, and walking ability. Patient activity was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination, and length of stay were extracted from the medical record. Results. The comprehensive stroke unit group included more males, fewer partial anterior circulation infarcts, more lacunar infarcts, and more patients ambulant without aids prior to their stroke. Patients in the comprehensive stroke unit spent 14.4% more (95% CI: 8.9%¨C19.8%; ) of the day in moderate or high activity, 18.5% less time physically inactive (95% CI: 5.0%¨C32.0%; ), and were more likely to be discharged directly home (OR 3.7; 95% CI 1.4¨C9.5; ). Conclusions. Comprehensive stroke unit care may foster early physical activity, with likely discharge directly home. 1. Introduction Evidence of the benefits of organised stroke unit care for the treatment of acute stroke is now well established [1]. Early physical activity has been identified as a key component of this care [2, 3], with two small randomised controlled trials of very early rehabilitation providing preliminary evidence for the benefits of early physical activity after stroke [4, 5]. The emergence of different models of stroke unit care has created a need for further research which directly compares these different models and examines the underlying components of care [1]. The acute stroke unit (ASU) and the comprehensive stroke unit (CSU) have been identified as common models of acute care for stroke [1]. There are few trials which directly compare these two stroke unit models [6¨C9] and there is currently insufficient evidence to confirm a greater benefit from either model [1]. In a recent review of the literature describing these two models of care we found that ASU care tends to have a greater emphasis on acute medical management, increased nurse staffing, early assessment and investigation, and intensive physiological monitoring, while CSU care appears to have a greater emphasis on
%U http://www.hindawi.com/journals/rerp/2013/498014/