-Rehabilitation of stroke patients is time consuming and expensive and therefore it is important to analyse critically the effect of several factors on patients' functional outcome. The specific components of rehabilitation that affect outcome after stroke remain to be investigated. Different regimes of rehabilitation of stroke patients are used in various countries but there is little research on the effect of this on outcome. Although a number of RCT's have shown the effect of well defined rehabilitation interventions, the modalities of treatment under scrutiny were often specific aspects of physical therapy or occupational therapy rather than more general approaches to rehabilitation. Many factors influence the outcome of therapy. If differences in outcome do occur, it is important to explore the underlying reasons.
The aim of the proposed study is to compare the outcomes of stroke rehabilitation in different centres across Europe and also to examine differences in amount and content of therapy, organisational characteristics and input of man-hours of staff.
Four principal components will be studied in an integrated way:
(1) Comparison of the pattern of recovery and outcome after stroke in four rehabilitation centres in four European countries. The centres to be involved in the study are all leading departments in stroke rehabilitation in their country.
(2) Identification of the difference in the provision of stroke services in these centres, which might account for differences in outcome. This includes consideration of the amount of time spent in therapy and the content of the physical and occupational therapy.
(3) Analysis of the organisational characteristics of the different units providing rehabilitation. The analysis focuses on three classes of variables: management and characteristics of labour division; staff characteristics and characteristics of the physical environment. Furthermore, qualitative research methods will allow to describe cultural differences and interaction processes.
(4) The final stage of the study will bring together these four elements, to identify the best clinical practice in stroke rehabilitation and to acquire evidence for best disease management and decision-making.
The final goal is to improve the management of stroke rehabilitation and to reduce the level of long-term disability of stroke patients. To achieve this goal a comparative study between 'leading' rehabilitation centres in four different European countries is set up to identify factors, both 'managerial' and 'clinical', that influence outcome.