Background: In Austria, rehabilitation is mainly provided as inpatient rehabilitation. In the last years however, an increase in outpatient (including neurological) rehabilitation can be observed. In the Austrian rehabilitation plan of 2012, aims for outpatient rehabilitation have been defined. These can be summarised as a higher flexibility of the therapy plan, a higher participation within the living environment, a higher activation of the self-help capability, a better re-integration into the work process and a better cooperation with aftercare units. Aim of this report (a master's thesis) is to analyse, whether outpatient stroke patients are able to achieve these goals.
Methods: In November 2014, we conducted a systematic literature search in five databases. In addition, we searched websites and references for relevant information. After de-duplication 853 sources were available for literature selection. We screened 29 full-text articles for meeting the inclusion criteria. We defined five domains (functionality, participation, satisfaction, re-integration into the work process and aftercare) for a structured data extraction.
Results: We included 9 publications of 7 observational pre-post studies (4 with control group). No randomised controlled trial could be identified. We extracted 32 results that had been obtained by 20 different instruments and assigned them to the five domains. For the domains "functionality" and "participation" most of the studies found positive effects. The heterogeneity of instruments led to different results in the domain "satisfaction". Positive trends could be observed for the domain "re-integration into the work process". Finally, none of the studies reported results for the domain "aftercare". Overall, the risk of bias of included studies has to be rated as high.
Conclusions: Outpatient neurological rehabilitation supports patients after stroke by improving their participation, self-help capability or re-integration into the work process. We did not aim at comparing different rehabilitation settings. Future studies should aim at the further standardisation of instruments, the randomised allocation of patients to the rehabilitation settings (to avoid a selection bias) and the investigation of patients' expectations and needs.