A comparison of stroke rehabilitation practice and outcomes between New Zealand and United States facilities

Objective: To compare stroke rehabilitation practice and outcomes between New Zealand (NZ) and the United States. Design: Prospective observational cohort study. Setting: Seven inpatient rehabilitation facilities (IRFs) in the United States and NZ. Participants: Consecutive convenience sample of 1161 patients in 6 U.S. IRFs and 130 in 1 NZ IRF (age, >18y) after acute stroke. Interventions: Not applicable. Main Outcome Measures: Change in FIM score and discharge destination. Results: NZ participants were older than U.S. participants (mean: 74.1y vs 66.0y, respectively; P<.001). Measures of initial stroke severity were higher for U.S. participants. Mean rehabilitation length of stay (LOS) was shorter for U.S. participants (18.6d vs 30.0d, P<.001), but physical and occupational therapy time per patient was considerably higher despite the shorter LOS. U.S. therapists were involved in more active therapies for more of the time. Outcomes were better for U.S. participants, with fewer discharged to institutional care (13.2% vs 21.5%, P=.006) and larger changes in FIM scores. Conclusions: U.S. participants with acute stroke who were selected for rehabilitation had better outcomes than NZ participants, despite shorter stays in the rehabilitation facility. U.S. participants had more intensive input from physiotherapists and occupational therapists, which may explain some of the larger increases in FIM scores. This suggests that further studies with tighter controls on case mix may add additional information on the effects of therapy intensity on patients with stroke.