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Background: Recovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa., Methods: This study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time., Results: The results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample., Conclusion: The results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

Objective: To determine the reliability of the road test performed by stroke patients., Design: Prospective study of a 6-month predriving evaluation., Setting: Driving safety center in Belgium., Participants: Thirty patients with sequelae of stroke., Interventions: Not applicable., Main Outcome Measures: Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations (CARA), in a car fitted with a video camera. A third assessor also evaluated all the video recordings. Interrater reliability was evaluated by comparing results from real-life performance and video recording, as judged by the CARA assessors and video judgments between CARA assessors and the third assessor., Results: Most subitems of the road test showed more than 80% scoring agreement between the various evaluations. Intraclass correlation coefficients (ICCs) of the items varied from -.08 to 1.0. The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and.80 in video versus video comparison., Conclusion: The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence. Yet, the reliability of some items needs further attention.

Objective: To identify variables that best predict a team's decision of driving ability in stroke patients from a predriving assessment., Design: Retrospective study of a 2-year predriving evaluation., Setting: Belgian Institute for Road Safety., Participants: One hundred four patients with sequelae of first stroke., Interventions: Predriving assessments and road test., Main Outcome Measures: The suitability to resume driving based on a team decision and performance in the road test., Results: Forty-one patients (39.4%) were judged suitable, 45 (43.3%) not immediately suitable, and 18 (17.3%) not suitable to drive. Correlation coefficients and comparisons between groups revealed that most variables had significant individual relationships with the team decision and performance on the road test. After logistic regression analysis, side of lesion, kinetic vision, visual scanning, and a road test led to the best model in predicting the team decision (R(2) =.53). The road test was the most important determinant (R(2) =.42). Multiple regression analysis showed that the combination of acuity of left and right eyes and the figure of Rey was the best subset to predict the road test (R(2) =.28)., Conclusion: The predictive accuracy of the team's decision is limited, and the road test is even lower. Inclusion of more real-road-related tests in the predriving assessment is necessary., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)