[Expectations of stroke patients concerning in-patient or out-patient neurological rehabilitation in Phase D].

Setting preferences and expectations before and appraisals and criticisms after neurological rehabilitation of stroke patients who fulfilled German phase-D criteria (cooperative and independent in basic ADL-functions) were longitudinally assessed in a rehabilitation centre with in-patient and out-patient facilities of comparable therapeutic quality and intensities, and followed-up for 6 months. 53 patients fulfilled inclusion criteria, of whom 16 opted for and received out-patient rehabilitation, 21 opted for out-patient rehabilitation but had to receive in-patient treatment mainly for geographical reasons, and 16 preferred and received in-patient rehabilitation. Setting preferences and setting assignment did not influence patients' expectations. When assessed at discharge and after 6 months, a considerable number of patients expressed changes in setting preferences and altered reasons for setting choice. At rehabilitation onset, patients were generally optimistic that rehabilitation would lead to an improvement of functional abilities and health status. This optimism was not fulfilled, although patients improved in functional independence/activities of daily life and physical dimensions of quality of life. The subjective realization of expectations was neither associated with setting preference nor with realized setting. Improvements of functional disabilities and independence were not correlated with rehabilitation satisfaction. Patients were less disappointed with rehabilitation outcome the more they improved in dimensions of quality of life (or vice versa). The fact that setting preferences are indifferent and not stable over time indicates deficits of information and decision capacity in rehabilitation patients after stroke and may be explained by characteristics of this disease and a specific, short time-limit for decision-making. For the evaluation of rehabilitation programmes, it can also be concluded that multidimensional assessments such as the SF-36 cannot be replaced by patient satisfaction scores.