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The benefits of stroke unit care are substantial, both in terms of improving activities of daily living and reducing disabilities (Zhang et al. 2014). As compared to general rehabilitation units, coordinated and organized rehabilitation care in a stroke unit has been shown to reduce mortality and hospital length of stay and to increase functional independence and quality of life (Stroke Unit Trialists’ Collaboration, 2013; Foley et al., 2007). Within a stroke unit, care is provided by an experienced interprofessional stroke team (including physicians, nurses, physiotherapists, occupational therapists, speech therapists, etc.) dedicated to the management of stroke patients (Stroke Unit Trialists’ Collaboration, 2013; Foley et al. 2013; Zhang et al. 2014; Saposnik et al. 2011), and often within a geographically defined space (Langhorne & Pollock, 2002). Stroke units also typically include staff members who have a specialist interest in stroke, participate in routine team meetings and continuing education/training, and involve caregivers in the rehabilitation process (Langhorne & Pollock, 2002). In addition to professional services rendered, it is encouraged that patients and their caregivers alike engage in early active involvement in the rehabilitation process (Scottish Intercollegiate Guidelines Network, 2010).
The Stroke Unit Trialists’ Collaboration identified 28 randomized and quasi-randomized trials (n=5,855) comparing stroke unit care with an alternative, less organized form of care (e.g., general medical ward) (Stroke Unit Trialists’ Collaboration, 2013). At a median one-year follow-up, stroke unit care was associated with a significant reduction in death (OR=0.76, 95% CI 0.66 to 0.88, p=0.0001), death or institutionalization (OR=0.76, 95% CI 0.67 to 0.86, p=0.0001), and death or dependency (OR=0.80, 95% CI 0.67 to 0.97, p<0.00001), as compared to an alternative form of care. Moreover, stroke unit care was found to be beneficial regardless of sex, age, or stroke severity, with benefits maintained in follow-up studies 5-10 years post-stroke (Stroke Unit Trialists’ Collaboration, 2013).
Seenan and colleagues identified 25 (n=42,236) observational studies to explore the benefits of stroke unit care in clinical practice (Seenan et al., 2007). As in pooled analyses of clinical trials, stroke unit care provided in clinical practice was found to be associated with a significant reduction in the odds of death (odds ratio=0.79, 95% CI=0.73 to 0.86; p<0.001) and of death or poor outcome (odds ratio=0.87, 95% CI=0.80 to 0.95; p=0.002; I2=45.5%) within one-year of stroke. Similar findings were reported for a secondary analysis limited to multi-centered trials (OR=0.82, 95% CI 0.77 to 0.87, p<0.001; I2=0%) (Seenan et al., 2007).
In another systematic review and meta-analysis, Foley and colleagues identified 14 trials comparing stroke unit care to conventional care (Foley et al., 2007). Included studies were categorized on the basis of the model of care provided (i.e., acute care, combined acute/rehabilitation, or rehabilitation). Based on the pooled results of 5 studies, post-acute rehabilitation stroke units were found to be associated with reduced odds of death (OR=0.60, 95% CI 0.44 to 0.81, p<0.05) and death or dependency (OR=0.63, 95% CI 0.48 to 0.83, p<0.05). Similar findings were reported with respect to combined acute/rehabilitation stroke units (death: OR=0.71, 95% CI 0.54 to 0.94; death/dependency: OR=0.50, 95% CI 0.39 to 0.65). Although Foley et al. (2007) reported that stroke rehabilitation units do not have a significant impact on length of stay (weighted mean difference=-13.2, 95% CI -48.3 to 21.9, p>0.05), there is evidence that patients with moderately severe strokes treated in stroke rehabilitation units are more likely to be discharged home (75% v. 52%, p<0.001) and are less likely to require institutionalization (22% vs. 44%, p<0.001) (Kalra et al. 1993).