Effects of day-hospital rehabilitation in stroke patients: A review of randomized clinical trials

The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were collected by a computer-aided search of published randomized trials. Fifteen articles reporting on seven randomized controlled trials were selected. Data extraction included a score for quality of the methods, based on four categories: "study population", "interventions", "effects" and "data presentation and analysis". To each criterion a weight was attached and the maximum score was set at 100 points. In judging the methodological quality of the selected studies, one study proved insufficient. Of the remaining studies the sum score varied from 34 to 67, with a mean of 50, Comparison of the results of the studies is complicated by different definitions of DHR, different natures of the control group and the study population, and the variety of measurement instruments applied. Often instruments were applied whose reliability and validity was not proven. As of now it is not possible to prove that DHR for stroke patients is effective. In future research a standardized definition of DHR, a uniform control group, an acceptable research methodology and adequate measurement instruments must be applied.