1143 JRRD JRRD Volume 51, Number 7, 2014 Pages 1143–1154 Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ Margaret G. Stineman, MD; 1–2 Dawei Xie, PhD; 1 Jibby E. Kurichi, MPH; 1* Pui L. Kwong, MPH; 1 W. Bruce Vogel, PhD; 3 Diane Cowper Ripley, PhD; 3 Barbara E. Bates, MD 4 1 Center for Clinical Epidemiology and Biostatistics and 2 Department of Physical Medicine and Rehabilitation, Uni- versity of Pennsylvania, Philadelphia, PA; 3 Center of Innovation on Disability and Rehabilitation Research, Malcom Randall Department of Veterans Affairs Medical Center (VAMC), Gainesville, FL; and Department of Health Out- comes and Policy, University of Florida, Gainesville, FL; 4 Samuel S. Stratton VAMC, Albany, NY; and Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY Abstract—Comprehensive rehabilitation services after acute stroke have been shown efficacious in European trials; however, their effectiveness in everyday practices in the United States is unknown. We compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with con- sultative rehabilitation services after acute stroke using propen- sity scores. Outcomes included change in patients’ physical and cognitive independence after rehabilitation, discharge to home as opposed to other settings, and 1-yr after hospital discharge sur- vival. Of the 2,963 patients in the study, 683 (23.1%) received comprehensive rehabilitation while the remaining patients received consultative services. We found, after propensity adjust- ment, that those who received comprehensive rehabilitation com- pared with consultative gained on average 12.8 (95% confidence interval [CI]: 9.1 to 16.5) more points of physical independence on a 78-point scale and gained 1.5 (95% CI: 0.8 to 2.2) more points of cognitive independence on a 30-point scale. The likeli- hoods of discharge to home from the hospital (odds ratio [OR] = 1.61, 95% CI: 1.07 to 2.44) and 1 yr posthospital discharge sur- vival (OR = 1.79, 95% CI: 1.25 to 2.56) were significantly higher among those who received comprehensive rehabilitation. Among patients hospitalized for acute stroke, comprehensive rehabilita- tion services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1 yr survival. Key words: acute stroke, cognitive independence, function, home discharge, outcomes, propensity risk score, rehabilitation services, stroke, survival, veterans. INTRODUCTION An estimated 795,000 people in the United States experience a new or acute stroke annually, with an esti- mated cost of $73.7 billion in 2010 [1]. Nearly half of those surviving 6 mo remain with neurological deficits, which can cause disabilities, reduce quality of life, burden Abbreviations: CARF = Commission on Accreditation of Rehabilitation Facilities, CI = confidence interval, FIM = Func- tional Independence Measure, FSOD = Functional Status Out- comes Database, GEE = general estimating equation, ICD-9- CM = International Classification of Diseases-Ninth Revision- Clinical Modification, ICU = intensive care unit, IRF = inpatient rehabilitation facility, OR = odds ratio, PAC = postacute care, PM&R = physical medicine and rehabilitation, PTF = patient treatment file, SD = standard deviation, SRU = specialized reha- bilitation unit, VA = Department of Veterans Affairs, VAMC = Department of Veterans Affairs Medical Center, VHA = Veter- ans Health Administration. * Address all correspondence to Jibby E. Kurichi, MPH; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, School of Medi- cine, University of Pennsylvania, 907 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021; 215-898-8490; fax: 215-573-2017. Email: jkurichi@mail.med.upenn.edu http://dx.doi.org/10.1682/JRRD.2014.03.0084