You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Five year follow up of a randomised controlled trial of a stroke rehabilitation unit
Abstract 1:
Caring for stroke patients in stroke units , compared with other hospital locations , leads to decreased mortality and disability at one year.1 A trial of a combined acute and rehabilitation ward in Trondheim , Norway , showed that hospital care improved survival and functional outcome at five years.2 The benefits were attributed to the treatment provided in the first few weeks after stroke . The purpose of this study was to examine the effects of care in a non-acute stroke unit on outcome at five years . The methods and findings of 315 patients at one year of our r and omised study comparing a non-acute stroke rehabilitation unit with care on conventional medical and geriatric wards  have been published.3 In the present study , we ascertained survival to five years by using hospital records and death certificates . Survivors were traced to establish their residential status and visited by a research er who was


Title 2:
Evaluation of rehabilitation methods in the hemiplegic patient.
Abstract 2:
Abstract Hemiplegic patients with an average age of 65 years , were r and omly assigned to a rehabilitation center ( the  control group ) and to a general hospital under the management of a nurse trained in rehabilitation procedures  ( the experimental group ) . Patients with severe impairment and aphasia were excluded . The two groups were similar in age , sex , residence accommodation prior to rehabilitation , duration of disability , degree of proficiency in self-care , intelligence , degree of perceptual motor deterioration , and available ‘ ego energy . ’ Minor differences between the two groups are discusssed in detail with reference to their effect on outcome . Improvement in living arrangements and self-care were effected equally by the rehabilitation team and rehabilitation nurse . In locomotion the experimental group did not do as well as the control group . The rehabilitation nurse demonstrated ability to manage the restorative care of hemiplegic patients , but severe grade s of disability require the rehabilitation center . The problems are discussed in respect to rating functional capacity in disability


Title 3:
The significance of intensity of rehabilitation of stroke--a controlled trial.
Abstract 3:
Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients


Title 4:
Outcome of subacute stroke rehabilitation: a randomized controlled trial.
Abstract 4:
BACKGROUND AND PURPOSE Organized acute stroke treatment reduces mortality , functional deficits , and the need of institutionalization after stroke . It is largely unknown whether the effects of treatment are due to early or subacute efforts . The aim of this r and omized , controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life . METHODS 251 patients initially treated in the hospital were r and omized to subacute rehabilitation in a hospital rehabilitation unit ( n = 127 ) or to the health services in the municipality ( n = 124 ) and were followed up for 7 months . RESULTS The combined outcome of patients being dead or dependent ( Barthel Index score of < 75 ) was 23 % in the hospital group and 38 % in the municipality group ( P=.01 ) . Seven-month survival rates were 90.6 % and 83.9 % ( P=.11 ) , respectively . Dependency in activities of daily living was 12.6 % in the hospital group and 25.0 % in the municipality group ( P=.07 ) . Patients with a BI score of < 50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit , with fewer patients becoming dependent ( P=.005 ) and patients having higher Sc and inavian Stroke Scale ( P=.026 ) and BI scores ( P=.005 ) . No significant differences in health-related quality of life were found . Many patients treated in the municipalities ( 30 % ) did not receive any organized rehabilitation in this study . CONCLUSIONS Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome .  Patients with moderate or severe stroke appear to benefit most


Title 5:
Improving Stroke Rehabilitation: A Controlled Study
Abstract 5:
Background and Purpose Assessment of stroke rehabilitation is complicated by the heterogeneity of patients and setting s and by difficulties in disentangling effects of organization from effects of types and amounts of treatment input . Methods A prospect i ve controlled study was undertaken in 245 stroke patients stratified into three groups according to prognosis and managed on a stroke rehabilitation unit ( n=124 ) or general medical wards ( n=121 ) . Patients were r and omly allocated to either setting 2 weeks after stroke and were comparable for baseline characteristics . Results Patients on general medical wards received more physiotherapy  on average ( 16.2 ± 7.2 versus 14.3 ± 3.2 hours ; P < .05 ) but similar amounts of  occupational therapy  ( 9.3 ± 2.8 versus 9.5 ± 3.2 hours ) compared with stroke unit patients . More time was spent on  individual rehabilitation on the stroke unit compared with general wards ( P < .001 ) . Functional abilities at discharge , destination of discharge , and length of hospital stay in patients with good prognosis were comparable in both setting s. Patients with poor prognosis managed on general wards showed higher mortality ( P < .05 ) and longer hospital stay ( 123.2 ± 48.2 versus 52.3 ± 19.8 days ; P < .001 ) , but functional abilities at discharge in survivors were comparable with those of stroke unit patients . Patients with intermediate prognosis had significantly better outcome on the stroke unit , with more patients being discharged home ( 75 % versus 52 % ; P < .001 ) , shorter average length of hospital stay ( 48.7 ± 17.2 versus 104.6 ± 28.6 days ; P < .001 ) , and better functional abilities at discharge ( P < .05 ) . Conclusions Stroke units improve outcome and reduce hospital stay without increasing therapy time . Their effectiveness may be enhanced by patient selection


Title 6:
A randomized controlled trial of a stroke rehabilitation ward.
Abstract 6:
In S.E. Kent , during 1978 and 1979 , 225 patients , representing 228 occurrences of hemiplegia , were referred to a new 20-bed stroke rehabilitation ward .  These patients were r and omly allocated to treatment in the special ward ( group A 112 strokes ) or to remain in conventional treatment locations ( group C 116 strokes ) ; the two groups were closely similar , except for the initial level of consciousness . Survivors were observed at four-month intervals to one year . There are indications of benefit for patients in group A by comparison with Group C in terms of treatment received ( number treated by remedial therapists , the extent of treatment , and the arrangements for after-care ) , and in outcome ( survival and the proportion returned to the community ) . The direction of the trend of advantage is consistent with another recent controlled trial , although not all modes of improvement are identical in the two trials . It is suggested that every health district should develop a comprehensive policy of stroke management


Title 7:
Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings.
Abstract 7:
OBJECTIVE To assess whether outcomes and costs differ for elderly patients admitted to rehabilitation hospitals , subacute nursing homes , and traditional nursing homes . DESIGN Inception cohort stratified by provider type and followed prospect ively for 6 months . SETTING A total of 92 hospital-based units and freest and ing facilities from 17 states . PATIENTS A total of 518 r and omly selected patients with hip fracture and 485 stroke patients admitted from November 1991 to February 1994 . MAIN OUTCOME MEASURES At 6 months comparing community residence , recovery to premorbid levels in 5 activities of daily living ( ADLs ) , Medicare costs , and the number of therapy and physician visits . Outcomes were adjusted for premorbid residence and function , caregiver availability , comorbid illness , admission function , cognition , depression , sensory deficits , and mobility impairments . RESULTS On admission , rehabilitation hospital patients were more likely ( P<.001 ) to have caregivers and better cognitive and physical function . Hip fracture patients admitted to rehabilitation hospitals did not differ from patients admitted to nursing homes in returning to the community ( adjusted odds ratio [ OR ] , 1.3 ; 95 % confidence interval [ CI ] , 0.6 - 2.6 ) or in the number of ADLs recovered to premorbid level ( difference , 0.09 ADL ; 95 % CI , -0.27 - 0.44 ) , but stroke patients admitted to rehabilitation hospitals were more likely to return to the community ( adjusted OR , 3.3 ; 95 % CI , 1.5 - 7.2 ) and recover ADLs ( difference , 0.63 ADL ; 95 % CI , 0.20 - 1.07 ) . Subacute nursing home patients with stroke were more likely than traditional nursing home patients to return to the community ( adjusted OR , 6.8 ; 95 % CI , 2.2 - 21.4 ) , there was no difference in return to the community for patients with hip fracture ( adjusted OR , 1.6 ; 95 % CI , 0.7 - 3.6 ) , and there were no differences in recovery of ADLs for either condition . Medicare costs were greater ( P<.001 ) for rehabilitation hospital patients than for subacute nursing home patients , and the costs for subacute nursing home patients were greater ( P=.03 for stroke and .009 for hip fracture ) than for traditional nursing home patients . CONCLUSIONS Study findings are consistent with enhanced outcomes for elderly patients with stroke treated in rehabilitation hospitals but not for patients with hip fracture . Subacute nursing homes were more effective than traditional nursing homes in returning patients with stroke to the community , despite comparable functional outcomes


Title 8:
Role of stroke rehabilitation units in managing severe disability after stroke.
Abstract 8:
BACKGROUND AND PURPOSE Stroke unit rehabilitation tends to be directed toward stroke patients with moderately severe disabilities ( " the middle group " ) . Data collected on a stroke rehabilitation unit , however , showed improving outcome over 3 years in patients with a poor prognosis ( discharge home : 48 % versus 16 % , P < .02 ; discharge Barthel Index score : 9 versus 6 , P < .05 ) . The hypothesis that stroke rehabilitation units may improve outcome in severely disabled stroke patients was tested in this study . METHODS A r and omized controlled study was undertaken in 71 patients with a poor prognosis who were treated either on a stroke rehabilitation unit ( n = 34 ) or on general wards ( n = 37 ) to compare outcome between the two groups . Data collected were also compared with those from a method ologically similar study undertaken 3 years ago . RESULTS Severe stroke patients treated on the stroke rehabilitation unit had a significantly better outcome compared with general wards ( mortality : 21 % versus 46 % , P < .05 ; discharge home 47 % versus 19 % , P < .01 ; median length of hospital stay : 43 versus 59 days , P < .02 ) . The number of stroke unit patients being discharged home had increased significantly from the previous study , with a trend toward improvement in median discharge Barthel Index score . CONCLUSIONS Stroke rehabilitation units may improve outcome in severe stroke patients . This improvement appears to be due to the development of innovative management strategies that reduce mortality and institutionalization and enable caregivers to support more disabled stroke patients at home
The results indicate that there can be substantial benefit from organized inpatient multidisciplinary rehabilitation in the postacute period , which is both statistically significant and clinical ly important