Focused Stroke Rehabilitation Programs Do Not Improve Outcome

Abstract

N eurologists have a growing interest in supervising the rehabilitation of patients with stroke and other neurologic diseases.¹ While it is a natural extension of what we do as physicians, inpatient rehabilitation is also a growing production: 72 free-standing and 423 critical care hospital units received $210 million in 1987 from Medicare, all of which was excluded from the prospective payment system.² As neurologists enter this stage, we should try to leave in the wings the chorus of rehabilitation specialists who lament that they cannot examine whether or not their programs improve important outcomes over those of the natural history of recovery, ie, when patients do not receive any therapy or when their therapy is nonspecific. A typical conclusion that was reached in 1 of the 38 studies that has published its outcomes in a refereed journal states³: Despite these methodologic limitations, this study confirmed the