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Many stroke rehabilitation services and interventions are complex in that they involve a number of components, interactions, and outcomes. Much of the onus of stroke care lies with rehabilitation services and because stroke rehabilitation is highly resource intensive, it is important for policy makers to consider the potential trade-offs between all relevant costs and benefits. The primary aim of this systematic review was to assess the methods used to conduct economic evaluations of stroke rehabilitation. Studies that compared two or more alternative stroke rehabilitation interventions or services with the costs and outcomes being examined for each alternative were included. EMBASE, MEDLINE In-Process, and National Health Service's Economic Evaluation Database were searched using search strategies. The methodological quality of the included studies was appraised using a checklist for the conduct and reporting of economic evaluations. Twenty-one studies met the selection criteria. The economic evaluations in the majority of these studies were inadequate based on their ability to identify, measure, and value all resources and benefits pertinent to the complexity of stroke rehabilitation. This study highlights that complex interventions such as stroke rehabilitation have widespread effects, which may not be represented by the changes on a single outcome. This study recommends the adoption of a wider cost and benefit perspective in the economic evaluations of complex interventions. It supports a move away from conventional economic evaluation and decision making, based purely on cost-effectiveness, toward multicriteria decision analysis frameworks for complex interventions, where a broader range of criteria may be assessed by policy makers., (© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.)

Regaining poststroke mobility is considered a primary goal of the stroke patient in early rehabilitation. Predictive recovery of poststroke mobility is clinically important, and provides important information to healthcare professionals, patients and their families. We conducted a systematic review aimed at identifying the predictive or associated baseline factors, assessed within one-week of stroke onset, and the recovery of poststroke mobility within 30 days. A comprehensive search strategy was applied to all major electronic databases to identify potentially relevant studies. Included in the review are two studies that evaluate the predictive value of baseline factors by developing a prognostic model, and three studies that assess the baseline factors that were associated with the outcome by univariate analysis. Walking is the most commonly assessed mobility outcome; age, the severity of paresis, reduced leg power, presence of hemianopia, size of brain lesion and type of stroke were shown to be predictive or associated with walking within 30 days poststroke. This review has identified the potential predictors of the recovery of mobility poststroke. There is a need to explore and validate these predictors in other patient cohorts, and consider additional factors believed to be associated with mobility. The recovery of mobility other than walking also needs investigation. In order to move prognostic research in stroke forward, a collaborative approach to sharing and collecting data is recommended., (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)