Avoiding Gaps After Stroke Unit Care: Impact of Direct Transition to Inpatient Neurorehabilitation on Post-stroke Outcomes

Introduction: Early initiation of neurorehabilitation (NR) at the stroke unit is recommended and has been associated with improved outcomes. However, ensuring a direct, uninterrupted transition to subsequent inpatient NR remains challenging in clinical practice. This study investigates whether direct transfer to inpatient NR is associated with functional recovery at 3-month post-stroke. Methods: This study is based on prospectively collected registry data of all stroke patients discharged with functional dependence (modified Rankin Scale [mRS] 3–5) from five stroke units in Styria, Austria, between 2012 and 2023. All patients received standardized inpatient NR, either immediately after acute stroke care or—due to limited NR bed availability—following interim care on a general neurological ward without specialized rehabilitation. The primary outcome was a ≥1-point mRS improvement from discharge to the 3-month follow-up. Outcome predictors were analyzed using univariable and multivariable methods. Results: Of 2,497 included patients (median age: 74 years; 44.7% female), 740 (29.6%) were directly transferred to NR after stroke unit care, while 1,757 patients (70.4%) were not, with a median delay to NR of 8 days. Improvement in mRS during follow-up was observed in 1,665 patients (66.7%). In multivariable analysis, direct transfer to NR was independently associated with mRS improvement (adjusted odds ratio 1.57, 95% CI 1.25-1.94) as were younger age, male sex, absence of prior stroke, and lower NIHSS score at discharge. Conclusions: Direct transition from the stroke unit to inpatient NR is associated with a greater likelihood of functional improvement at 3 months post-stroke. These findings support the value of implementing continuous post-stroke rehabilitation pathways.