Table 2 Characteristics of trials included in the meta-analysis
Trial | Design | Total number of patients | Age | Female% | Inclusion criteria | Stroke unit | General medical ward | Inpatient stay | Follow-up | Study quality (++, + or -)* |
|---|---|---|---|---|---|---|---|---|---|---|
RCT | 608 | SU: 70.5 GMW: 70.8 | Unknown | Acute stroke (onset to admission < 24 h) | Unknown | Unknown | Unknown | 1 month 1 year 5 years 6.5 years | - | |
Akershus [17] | CCT | 550 | SU: 77 GMW: 76 | SU: 47% GMW: 47% | ≥ 60 years; acute stroke (onset to admission < 24 h) | Multidisciplinary collaboration + early examination + early mobilization (first hours after admission) + management on fluid, fever, hyperglycemia, hypertension | Good medical treatment without special effort or standardized effort towards this patient group. Patients with hemorrhages were often immobilized for 1 week. No routine of giving antipyretics or parenteral iso-osmolar fluids. | SU: 9.5 days GMW: 7.7 days | 7 months | - |
Stockholm [20] | CCT | 494 | SU: 73 GMW: 74 | SU: 55% GMW: 63% | Stroke onset within the previous week or TIA onset within last month | Multidisciplinary collaboration + strict criteria for diagnosis and treatment + early active approach to mobilization and rehabilitation | Resources for general patient care in the GMW and SU were not different. Principles of investigation and management of stroke differed, according to routine of consulting physicians | SU: 21 days GMW: 20 days | Till discharge | - |
Beijing [21] | RCT | 392 | 62 | Unknown | ≥ 18 years; stroke | Multidisciplinary collaboration + early mobilization | Unknown | Unknown | Till discharge | - |
RCT | 311 | Unknown | Unknown | ≥ 60 years Conscious, established or developing hemiplegia, mean interval from stroke onset to admission: 24 h | Delay in starting physiotherapy treatment in SU: 3 days, in GMW: 3.8 days. No great differences in the use of speech therapy between SU and GMW. More aids or adaptations prescribed in SU to patient at discharge. | Unknown | SU: 55 days GMW: 75 days | 60 days 1 year | - | |
Umea [24] | CCT | 293 | SU: 72 GMW: 73 | SU: 42% GMW: 46% | Acute stroke or TIA ( onset to admission < 7 days) | No facility for intensive care. Multidisciplinary collaboration + early rehabilitation | No standardized program or extra resources for stroke care. Same clinical assessment on admission. Regimes for treatment are uniform. | SU: 21 days GMW: 31 days | 1 year | - |
Goteborg-Sahlgren [12] | RCT | 249 | SU: 80 GMW: 80 | SU: 66% GMW: 54% | ≥ 70 years; Acute stroke (onset to admission < 7 days, 80% in 24 h) | Multidisciplinary collaboration + standard examination on admission + monitoring of body temperature, glucose level, fluid, electrolyte balance + discharge planning | No standardized program or extra resources for the management of stroke patients. CT scan performed in 90% of patients | SU: 28.3 days GMW: 35.8 days | 3 weeks 3 months 1 year | ++ |
Trondheim [25] | RCT | 220 | SU: 72 GMW: 74 | SU: 49% GMW: 50% | Acute stroke (onset to admission < 7 days) | Multidisciplinary approach + standard examination (e.g. CT in 24 h of admission) + management on blood pressure, fever, glucose level, fluid, electrolyte balance, cardiac and pulmonary disorders, oxygen | Common treatment for patients with acute stroke in Norwegian hospitals. No standardized program for diagnostic evaluation and treatment | SU: 16 days | 52 weeks 5 years 10 years | + |
Joinville [26] | RCT | 74 | SU: 65 GMW: 71 | SU: 43% GMW: 41% | Acute stroke (onset to admission < 7 days) | Multidisciplinary collaboration | Routine medical investigation or treatment by neurologists, physiotherapist, occupational therapist were identical to that undertaken at SU | SU: 11 days GMW: 13 days | 10 days 1 month 3 months 6 months | - |
Perth [27] | RCT | 59 | SU: 69 GMW: 71 | SU: 59% GMW: 47% | Acute stroke (< 7 days duration) | Multidisciplinary collaboration | General physician, medical registrar and resident, ward nurse and allied health staff | SU: 24 days GMW: 27 days | 6 months | + |