Stroke recovery and rehabilitation research.

In my 29-year career as a physical therapist, I have always believed stroke rehabilitation was a good thing and it should be provided to most everyone. However, evidence-based practice requires us to know what works and who benefits and to know if stroke rehabilitation is cost-effective. Currently, there is tremendous variability in the structure and process of rehabilitation services in Department of Veterans Affairs (VA) facilities. Despite demonstrated efficacy, veterans have limited access to organized rehabilitation unit care. For example, only 50 percent of veterans with acute stroke were cared for in VA hospitals with organized rehabilitation units [1] and 27 percent are cared for in VA hospitals with neither a geriatric unit nor rehabilitation unit. Additionally, rehabilitation services in the VA are currently being reorganized and reduced. In the past 5 years, the number of rehabilitation units has decreased from 72 to 37 (–49 percent). All of these changes are occurring in the presence of converging evidence that well-organized multidisciplinary rehabilitation improves outcomes for individuals with stroke [2–5]. Recently completed VA Health Services Research and Development (HSR&D) and Rehabilitation Research and Development (RR&D) studies have demonstrated that processes and structures of postacute rehabilitation stroke care are associated with better patient outcomes and that better structure is associated with improved processes [6–8]. In addition, emerging evidence supports the efficacy of new therapeutic interventions [9–11]. However, we know little about the characteristics (timing, intensity, or duration) that are most beneficial, which patients benefit the most, or whether patients and their families value the ultimate outcomes. There is an urgent need to make additional strides in stroke rehabilitation research. Stroke is one of the major causes of long-term disability among adults, and its prevalence will continue to rise as the population ages. The Veterans Health Administration (VHA) estimates that each year over 15,000 veterans are hospitalized for stroke. Forty percent of these stroke survivors are left with moderate functional impairments and 15 to 30 percent severe disability. Even among those with “mild stroke,” significant residual deficits may limit mobility, increase risk for falls, and limit community reintegration and quality of life. All stroke survivors and their families are hopeful that research will one day help them. In March 2002, the National Institute of Neurological Diseases and Stroke released a report to develop a 10-year strategic plan for research. The report identified many priorities for stroke research, and it specifically targeted the need for expanded research in rehabilitation and recovery. The priorities identified for stroke rehabilitation and recovery research include (1) investigation of the neurobiology of recovery, (2) promotion of evidence-based investigations of innovative therapies compatible Pamela W. Duncan, PhD, PT, FAPTA Senior Career Scientist and Director of Rehabilitation Outcomes Research Center at the North Florida South Georgia Veterans Health System, Professor in the Departments of Health Services Administration and Physical Therapy in the College of Health Professions at the University of Florida, and Director of the Brooks Center for Rehabilitation Studies at the University of Florida