Editorials

Specialist rehabilitation after stroke

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7047.1623 (Published 29 June 1996) Cite this as: BMJ 1996;312:1623
  1. John Gladman,
  2. David Barer,
  3. Peter Langhorne
  1. Senior lecturer Department of Health Care of the Elderly, University Hospital, Nottingham NG7 2UH
  2. Professor Department of Medicine for the Elderly, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
  3. Senior lecturer in geriatric medicine Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow G4 0SF

    Effective in the short term, but more work needed in the long term

    The era of nihilism about stroke rehabilitation must surely have ended with the publication of a recent overview showing that patients cared for in specialist stroke units are significantly less likely to die than those cared for on ordinary wards.1 Organised stroke care lowers mortality without increasing the number of dependent survivors, since the reduction in the combined endpoint of death or institutionalisation is even greater (34%) than the reduction in mortality alone (21%).2 A decrease in odds of 34% is equivalent to an absolute reduction in risk of about 10%—far greater than the accepted benefits of thrombolysis for heart attack.

    But these and other overviews3 raise several issues. Firstly, if a cumulative meta-analysis of the trials had been undertaken as they were published convincing evidence of benefit would have emerged at least 10 years earlier (P Langhorne, unpublished data). Secondly, the trials used different techniques for …

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