• Koh Gerald Choon-Huat GC Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore. ephkohch@nus.edu.sg, Sanjiv K Saxena, Tze-Pin Ng, David Yong, and Ngan-Phoon Fong.
• Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore. ephkohch@nus.edu.sg
• Arch Phys Med Rehabil. 2012 Feb 1; 93 (2): 279-86.

ObjectiveTo examine the effect of duration, participation rate, and supervision during community rehabilitation on functional outcome during the first poststroke year.DesignProspective longitudinal study with interviews at admission, discharge, 1 month, 6 months, and 1 year after discharge.SettingTwo subacute inpatient rehabilitation units and the community after discharge in Singapore.ParticipantsSubacute nonaphasic stroke patients (N=215).InterventionParticipation rate in supervised therapy (at an outpatient rehabilitation center) and unsupervised therapy (at home) as defined as proportion of time performing therapy as prescribed by the subacute hospital's multidisciplinary rehabilitation team at discharge.Main Outcome MeasurePerformance of activities of daily living as measured by Barthel Index (BI) score at 1 year and improvement in BI scores between adjacent timepoints.ResultsAt 1 month after discharge, 33.3% were performing supervised therapy more than 25% of the recommended time, and 66.3% of subjects were performing unsupervised therapy more than 75% of the recommended time. On a mixed-model analysis, the independent predictors of lower BI scores were older age, hypertension, greater cognitive impairment, greater depressive symptoms, and greater neurologic impairment. Adjusting for these independent factors, performance of supervised therapy at 1 (β=8.8; 95% confidence interval [CI], 0.5-17.0; P=.039) and 6 (β=20.1; 95% CI, 11.0-29.2; P<.001) months postdischarge, but not unsupervised therapy, predicted better BI score at 1 year. Those who performed supervised therapy more than 25% of the recommended time achieved their maximal functional recovery faster than those who performed supervised therapy 25% or less of the recommended time (1 mo vs 6 mo).ConclusionsSupervised stroke rehabilitation in the community at 1 and 6 months was associated with better functional status at 1 year than unsupervised therapy, and a higher participation rate in supervised therapy was associated with greater and faster functional recovery.Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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