Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Medical records of all residents of Rochester, Minnesota, who had a first stroke in 1975-1979 were reviewed to determine level of disability, disposition, and use of rehabilitation services. Of the 292 persons with a first stroke, 251 (86%) (mean age 70 years) survived greater than 1 week. The mean Rankin disability score (Grade 1, no disability, through Grade 5, severe disability) changed from 1.7 before stroke to 2.8 in survivors at hospital discharge; 29% of those discharged required further institutional care. The level of disability in survivors remained relatively constant from 6 months after stroke through 5 years of observation. Of the 112 patients with an admission score of 5, 40 (36%) were alive at 1 year and only 5 of those (13%) improved to relative independence (Rankin scores of 1 or 2). The most common comorbidity contributing to disability was cardiovascular disease (31%). After the first 18 months, the mortality in patients with stroke was similar to that in a normal population having the same age and sex distribution. Of the 251 1-week survivors, 132 (53%) had rehabilitation (physiatrist) evaluations, 127 (51%) received physical therapy, 103 (41%) received occupational therapy, and 33 (13%) received speech therapy. Thirty-four of the 132 patients (26%) referred for rehabilitation evaluations were transferred to the rehabilitation unit.