Avoiding Gaps After Stroke Unit Care: Impact of Direct Transition to Inpatient Neurorehabilitation on Post-stroke Outcomes.

Abstract

Introduction: Early initiation of neurorehabilitation (NR) at the stroke unit is recommended and has been associated with improved outcomes. However, ensuring a direct, uninterrupted transition to subsequent inpatient NR remains challenging in clinical practice. This study investigates whether direct transfer to inpatient NR is associated with functional recovery at 3-month post-stroke.

Methods: This study is based on prospectively collected registry data of all stroke patients discharged with functional dependence (modified Rankin Scale [mRS] 3-5) from five stroke units in Styria, Austria, between 2012 and 2023. All patients received standardized inpatient NR, either immediately after acute stroke care or-due to limited NR bed availability-following interim care on a general neurological ward without specialized rehabilitation. The primary outcome was a ≥1-point mRS improvement from discharge to the 3-month follow-up. Outcome predictors were analyzed using univariable and multivariable methods.

Results: Of 2,497 included patients (median age: 74 years; 44.7% female), 740 (29.6%) were directly transferred to NR after stroke unit care, while 1,757 patients (70.4%) were not, with a median delay to NR of 8 days. Improvement in mRS during follow-up was observed in 1,665 patients (66.7%). In multivariable analysis, direct transfer to NR was independently associated with mRS improvement (adjusted odds ratio 1.57, 95% CI 1.25-1.94) as were younger age, male sex, absence of prior stroke, and lower NIHSS score at discharge.

Conclusions: Direct transition from the stroke unit to inpatient NR is associated with a greater likelihood of functional improvement at 3 months post-stroke. These findings support the value of implementing continuous post-stroke rehabilitation pathways.