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Bachani AM, Bentley JA, Kautsar H, Neill R, Trujillo AJ. Suggesting global insights to local challenges: expanding financing of rehabilitation services in low and middle-income countries. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1305033. [PMID: 38711833 PMCID: PMC11070479 DOI: 10.3389/fresc.2024.1305033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/03/2024] [Indexed: 05/08/2024]
Abstract
Purpose Following the rapid transition to non-communicable diseases, increases in injury, and subsequent disability, the world-especially low and middle-income countries (LMICs)-remains ill-equipped for increased demand for rehabilitative services and assistive technology. This scoping review explores rehabilitation financing models used throughout the world and identifies "state of the art" rehabilitation financing strategies to identify opportunities and challenges to expand financing of rehabilitation. Material and methods We searched peer-reviewed and grey literature for articles containing information on rehabilitation financing in both LMICs and high-income countries. Results Forty-two articles were included, highlighting various rehabilitation financing mechanism which involves user fees and other innovative payment as bundled or pooled schemes. Few studies explore policy options to increase investment in the supply of services. Conclusion this paper highlights opportunities to expand rehabilitation services, namely through promotion of private investment, improvement in provider reimbursement mechanism as well as expanding educational grants to bolster labor supply incentive, and the investment in public and private insurance schemes. Mechanisms of reimbursement are frequently based on global budget and salary which are helpful to control cost escalation but represent important barriers to expand supply and quality of services.
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Affiliation(s)
- Abdulgafoor M. Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jacob A. Bentley
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Antonio J. Trujillo
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Hazen EM, Bartsch BL, Billinger SA. Financial Cost Analysis Associated with a Locomotor Exercise Randomized Controlled Trial in Chronic Stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.20.23300342. [PMID: 38196625 PMCID: PMC10775328 DOI: 10.1101/2023.12.20.23300342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Post-stroke recovery trials pose distinct recruitment and retention challenges, and understanding the financial requirements of conducting randomized controlled trials is crucial to ensure sufficient resources for successful study execution. The purpose of this analysis was to quantify the costs at a single site with a large catchment area of the Moderate-Intensity Exercise Versus High-Intensity Interval Training to Recover Walking Post-Stroke, HIT Stroke Trial. Methods To determine cost, study expense reports were gathered and divided into four categories: oversight, recruitment, retention, and outcome assessments. Categories were then further divided into chronological order for initial contact and prescreening, consenting, initial screening, and baseline testing. The 12-week intervention was divided into 4-week blocks: intervention block 1, post 4-week outcome testing, intervention block 2, post 8-week outcome testing, intervention block 3, and post 12-week outcome testing. Results Total direct cost for site execution was $539,768 with cost per participant approximated as $35,984. Oversight costs accounted for 65.8% of the budget at $355,661. To achieve goals related to inclusive participant recruitment ($21,923) and retention ($28,009), our site costs totaled $49,932. Direct study-related costs included screening assessments ($5,905), baseline assessments ($15,028), intervention ($76,952), and outcome assessments ($36,288). Conclusion Clinical trials on walking rehabilitation and exercise, especially those involving multiple assessment visits, require intensive oversight. This cost analysis provides important and critical insight into the expenses required to successfully execute an exercise-based walking rehabilitation trial in the United States.
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Affiliation(s)
- Emily M. Hazen
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Bria L. Bartsch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS
| | - Sandra A. Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS
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Gaboury I, Dostie R, Corriveau H, Demoustier A, Tousignant M. Use of a Telerehabilitation Platform in a Stroke Continuum: A Qualitative Study of Patient and Therapist Acceptability. Int J Telerehabil 2022; 14:e6453. [PMID: 38026556 PMCID: PMC10681045 DOI: 10.5195/ijt.2022.6453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
The purpose of this study was to describe the acceptability of a stroke telerehabilitation platform from the perspective of both patients and therapists. Two public rehabilitation centers participated in a pilot telerehabilitation trial. A theoretical framework was used to conceptualize acceptability. Semi-structured individual interviews with patients and focus groups of therapists were conducted. Most participants and therapists were satisfied with the intervention. Participants emphasized the advantages of staying at home to get their treatments. Therapists were more skeptical at first about their self-efficacy to deliver therapy remotely. There was a consensus among therapists about the need for a combination of telerehabilitation and in-person visits to optimize treatments. While we found overall good acceptability, effectiveness of this technology could be improved via an accessible user interface, complementary rehabilitation material, and ongoing training and technical just-in-time support with therapists.
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Affiliation(s)
- Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Rosalie Dostie
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Hélène Corriveau
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Arnaud Demoustier
- School of Nursing, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Qian H, Chen S, Chen Y, Chang Y, Li Y, Dou S, Chen Q, Wang G, Xie M. Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage. Neurologist 2022; 27:89-94. [PMID: 34855671 DOI: 10.1097/nrl.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear. METHODS Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH. RESULTS After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group. CONCLUSION CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.
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Affiliation(s)
- Hong Qian
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shuangxi Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yarui Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yunqian Chang
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yihui Li
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Shiying Dou
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Qianlan Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Gang Wang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ming Xie
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
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Chen S, Huang J, Yao L, Zeng Y, Quan H, Kang H, Ou Y, Chen S. Internet+Continuing Nursing (ICN) Program Promotes Motor Function Rehabilitation of Patients With Ischemic Stroke. Neurologist 2021; 27:56-60. [PMID: 34842574 DOI: 10.1097/nrl.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is a severe disorder with high rates of death and recurrence that causes disability in patients and for which there is currently no effective treatment. Internet-based rehabilitation helps patients with disability recover at home with the help of their household or family members in a nonclinical setting. However, the effects of the internet+continuing nursing (ICN) program on the recovery of patients after ischemic stroke remains unknown. METHODS In the present study, patients were treated with an ICN-based rehabilitation training program; subsequently, the Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life were performed to evaluate the effects of the ICN program on patient self-confidence to persist with rehabilitation, functional exercise compliance, motor function, ability to live independently and quality of life following ischemic stroke. RESULTS We observed that, after the ICN intervention for 6 weeks and 3 months, the scores of Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life in the ICN-treated group were significantly higher compared with those in the control group. CONCLUSION These results suggested that the ICN program may promote the recovery of patients after ischemic stroke.
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Affiliation(s)
- Shuangqin Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang, Hunan, People's Republic of China
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Han Y, Varadarajan A, Kim T, Zheng G, Kitani K, Kelliher A, Rikakis T, Park YL. Smart Skin: Vision-Based Soft Pressure Sensing System for In-Home Hand Rehabilitation. Soft Robot 2021; 9:473-485. [PMID: 34415805 PMCID: PMC9232239 DOI: 10.1089/soro.2020.0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We introduce a novel in-home hand rehabilitation system for monitoring hand motions and assessing grip forces of stroke patients. The overall system is composed of a sensing device and a computer vision system. The sensing device is a lightweight cylindrical object for easy grip and manipulation, which is covered by a passive sensing layer called "Smart Skin." The Smart Skin is fabricated using soft silicone elastomer, which contains embedded microchannels partially filled with colored fluid. When the Smart Skin is compressed by grip forces, the colored fluid rises and fills in the top surface display area. Then, the computer vision system captures the image of the display area through a red-green-blue camera, detects the length change of the liquid through image processing, and eventually maps the liquid length to the calibrated force for estimating the gripping force. The passive sensing mechanism of the proposed Smart Skin device works in conjunction with a single camera setup, making the system simple and easy to use, while also requiring minimum maintenance effort. Our system, on one hand, aims to support home-based rehabilitation therapy with minimal or no supervision by recording the training process and the force data, which can be automatically conveyed to physical therapists. In contrast, the therapists can also remotely instruct the patients with their training prescriptions through online videos. This study first describes the design, fabrication, and calibration of the Smart Skin, and the algorithm for image processing, and then presents experimental results from the integrated system. The Smart Skin prototype shows a relatively linear relationship between the applied force and the length change of the liquid in the range of 0-35 N. The computer vision system shows the estimation error <4% and a relatively high stability in estimation under different hand motions.
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Affiliation(s)
- Yuanfeng Han
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aadith Varadarajan
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Taekyoung Kim
- Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering Research, Seoul National University, Seoul, Korea
| | - Gang Zheng
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Kris Kitani
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Aisling Kelliher
- Department of Computer Science, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Thanassis Rikakis
- Department of Bioengineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Yong-Lae Park
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.,Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering Research, Seoul National University, Seoul, Korea
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Feasibility of a Nurse-Trained, Family Member-Delivered Rehabilitation Model for Disabled Stroke Patients in Rural Chongqing, China. J Stroke Cerebrovasc Dis 2020; 29:105382. [PMID: 33096497 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Stroke rehabilitation was seriously inadequate in rural regions of China. This study aimed to evaluate the feasibility of a novel nurse-trained, family member-delivered rehabilitation model for disabled stroke patients in rural southwest China. METHODS A single-center randomized controlled trial was conducted at a rural county hospital in Chongqing, China. Eligible stroke patients were randomly assigned to an intervention group or to a control group. In the intervention group, patients and their caregivers received stroke rehabilitation training focusing on mobility, self-care, and toileting delivered by trained nurses before discharge, and 3 post-discharge telephone calls at 2nd, 4th, and 8th week. The control group received routine care. The primary outcome was functional independence indicating by Barthel Index (BI) scores, and secondary outcomes included health-related quality of life (EuroQol five dimensions questionnaire, EQ-5D) and caregiver burden (Caregiver Burden Inventory, CBI). Outcome assessment was carried out at pre-discharge, 3- and 6-months after discharge. RESULTS A total of 61 stroke patients were recruited and randomly assigned to the intervention group (n=31) or the control group (n = 30). Compared with that in the control group, BI increased more at 3 months and decreased less at 6 months in the intervention group, there was a significant difference in mean BI scores across the three time points (F = 21.96, p = 0.0001), but no significant between-group difference (F = 0.94, p = 0.3371). In the intervention group, BI scores at 3-and 6-months post-discharge were higher than that before discharge (t = 8.38, p = 0.0001; t = 4.14, p = 0.0003). In the control group, BI scores at 3 months were higher than that before discharge (t = 5.29, p = 0.0001), but no significant difference at 6 months. At 6 months post-discharge, the intervention group and the control group had similar EQ-5D scores (p = 0.91), and similar CBI scores (3.67 vs 3.68, p = 0.98). CONCLUSIONS The study showed that the novel nurse-trained, family member-delivered rehabilitation model improved physical recovery indicated by BI scores without increasing caregiver burden, compared to usual care, for rural stroke patients in southwest China.
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Neale S, Leach K, Steinfort S, Hitch D. Costs and length of stay associated with early supported discharge for moderate and severe stroke survivors. J Stroke Cerebrovasc Dis 2020; 29:104996. [PMID: 32689626 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 11/17/2022] Open
Abstract
GOAL This study aimed to compare the length of stay, saved days and service costs associated with an early supported discharge model of care for mild, moderate and severe stroke survivors, to standard treatment. MATERIALS AND METHODS A two centre cohort study, employing a quasi-experimental design with a control group of convenience. Forty-four participants were recruited when they were deemed suitable for discharge home with intensive rehabilitation and services, with three dropouts from the treatment group (treatment n = 28, control n = 13). There were no significant differences between the groups for gender, age, Functional Independence Measure, Berg Balance Test and Modified Ranking Scale total scores at baseline. There were also no significant differences between the groups for subsequent readmissions or complications. Length of stay was measured by the days between admission and discharge from both inpatient and community services. Costs were measured by daily amounts calculated for this service. FINDINGS The treatment group spent significantly fewer days on the acute and inpatient rehabilitation wards, with over half avoiding subacute admission altogether. However, the control group spent significantly fewer days receiving intensive rehabilitation. The treatment group cost less on average per patient, but was not significantly different in terms of overall costs per admission. CONCLUSION Stroke survivors receiving an early supported discharge model of care spent fewer days in hospital, frequently avoided subacute admission and incurred less cost per patient than those receiving standard treatment. These findings indicate that early supported discharge reduces length of inpatient stay, for a similar cost to standard treatment.
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Affiliation(s)
- Sharon Neale
- Western Health, Sunshine Hospital, Furlong Road, St Albans, Victoria 3021.
| | - Kathleen Leach
- Western Health, Sunshine Hospital, Furlong Road, St Albans, Victoria 3021.
| | - Sarah Steinfort
- Western Health, Sunshine Hospital, Furlong Road, St Albans, Victoria 3021.
| | - Danielle Hitch
- Western Health, Sunshine Hospital, Furlong Road, St Albans, Victoria 3021; Deakin University, Waterfront Campus, 1 Gheringhap Street, Geelong Victoria 3217.
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Systematic Review and Meta-Analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-Dwelling Patients With a Stroke. Arch Phys Med Rehabil 2019; 101:359-373. [PMID: 31689417 DOI: 10.1016/j.apmr.2019.10.181] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of home-based rehabilitation on improving physical function in home-dwelling patients after a stroke. DATA SOURCES Various electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health, Embase, the Cochrane Central Register of Controlled Trials, and 2 Chinese data sets (ie, Chinese Electronic Periodical Services and China Knowledge Resource Integrated) were searched for studies published before March 20, 2019. STUDY SELECTION Randomized controlled trials conducted to examine the effect of home-based rehabilitation on improving physical function in home-dwelling patients with a stroke and published in English or Chinese were included. In total, 49 articles in English (n=23) and Chinese (n=26) met the inclusion criteria. DATA EXTRACTION Data related to patient characteristics, study characteristics, intervention details, and outcomes were extracted by 2 independent reviewers. DATA SYNTHESIS A random-effects model with a sensitivity analysis showed that home-based rehabilitation exerted moderate improvements on physical function in home-dwelling patients with a stroke (g=0.58; 95% CI, 0.45∼0.70). Moderator analyses revealed that those patients with stroke of a younger age, of male sex, with a first-ever stroke episode, in the acute stage, and receiving rehabilitation training from their caregiver showed greater improvements in physical function. CONCLUSIONS Home rehabilitation can improve functional outcome in survivors of stroke and should be considered appropriate during discharge planning if continuation care is required.
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Ribeiro O, Brandão D, Oliveira AF, Martín I, Teixeira L, Paúl C. The Modified Caregiver Strain Index: Portuguese version. J Health Psychol 2019; 26:1597-1608. [DOI: 10.1177/1359105319883933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Modified Caregiver Strain Index is a widely used tool to screen for caregiver strain in family caregivers. This study presents the Portuguese version of the Modified Caregiver Strain Index and explores its psychometric properties in a sample of 347 informal caregivers of older dependent individuals. Factor analysis revealed a two-factor structure and indicated satisfactory internal consistency. Criterion-related validity was supported by positive significant correlations with the emotional health of the caregiver (psychological distress). The findings show evidence of reliability and validity of the Portuguese version of the Modified Caregiver Strain Index encouraging its use in clinical and research fields.
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Affiliation(s)
- Oscar Ribeiro
- Department of Education and Psychology, University of Aveiro (DEP-UA), Portugal
- Center for Health Technology and Services Research (CINTESIS), Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Portugal
| | - Daniela Brandão
- Center for Health Technology and Services Research (CINTESIS), Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Portugal
| | - Ana Filipa Oliveira
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Portugal
| | - Ignacio Martín
- Department of Education and Psychology, University of Aveiro (DEP-UA), Portugal
- Center for Health Technology and Services Research (CINTESIS), Portugal
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Portugal
- Public Health Institute, University of Porto (ISPUP), Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Portugal
- Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Portugal
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Bobin M, Bimbard F, Boukallel M, Anastassova M, Ammi M. SpECTRUM: Smart ECosystem for sTRoke patient׳s Upper limbs Monitoring. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.smhl.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hanna K, Rowe F. Orthoptic Home Visits for Stroke Survivors: Results from a UK Professional Practice Survey. Br Ir Orthopt J 2019; 15:105-114. [PMID: 32999981 PMCID: PMC7510398 DOI: 10.22599/bioj.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Orthoptists are perhaps the only allied health profession without a standard home visits service in the UK, although it could arguably be of benefit to many orthoptic patients. The aim of this survey was to identify whether home visits are being offered, or have the potential to be offered, within the orthoptic profession. Method: A survey of the orthoptic professional body (BIOS) for the UK and Ireland was developed and data collected between January and March 2016. Descriptive analysis was used to report the quantitative findings. A thematic analysis approach was undertaken for the written responses within the free-text boxes of the survey. Results: 461 BIOS members responded to the survey (response rate of 30.7%). Ten hospital sites (3.7%) reported offering home visits, and 444 members (96.3%) reported that they do not offer home visits, with little desire or perceived need for such a service. Only certain patients reportedly meet requirements for an orthoptic home visit, including those unable to attend the hospital due to poor health, transport issues, reduced cognition, stroke and learning difficulties. Implementation barriers were reported including staff safety, assessment quality and cost. Conclusion: Home visits are infrequently conducted within the orthoptic profession. However, where offered, certain patient groups were suggested to benefit from this service when they cannot attend hospital and thus, home visits could present a viable means of providing equitable visual care. Future research is required to explore orthoptic home visits compared to other forms of rehabilitation, and address concerns from the orthoptic professional body.
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Beresford B, Mann R, Parker G, Kanaan M, Faria R, Rabiee P, Weatherly H, Clarke S, Mayhew E, Duarte A, Laver-Fawcett A, Aspinal F. Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Reablement is an intensive, time-limited intervention for people at risk of needing social care or an increased intensity of care. Differing from home care, it seeks to restore functioning and self-care skills. In England, it is a core element of intermediate care. The existing evidence base is limited.
Objectives
To describe reablement services in England and develop a service model typology; to conduct a mixed-methods comparative evaluation of service models investigating outcomes, factors that have an impact on outcomes, costs and cost-effectiveness, and user and practitioner experiences; and to investigate specialist reablement services/practices for people with dementia.
Methods
Work package (WP) 1, which took place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. WP2 was an observational study of three reablement services, each representing a different service model. Data were collected on health (EuroQol-5 Dimensions, five-level version) and social care related (Adult Social Care Outcomes Toolkit – self-completed) quality of life, practitioner (Barthel Index of Activities of Daily Living) and self-reported (Nottingham Extended Activities of Daily Living scale) functioning, individual and service characteristics, and resource use. They were collected on entry into reablement (n = 186), at discharge (n = 128) and, for those reaching the point on the study timeline, at 6 months post discharge (n = 64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. In WP3, staff in eight reablement services were interviewed to investigate their experiences of reabling people with dementia.
Results
A total of 201 services in 139 local authorities took part in the survey. Services varied in their organisational base, their relationship with other intermediate care services, their use of outsourced providers, their skill mix and the scope of their reablement input. These characteristics influenced aspects of service delivery and practice. The average cost per case was £1728. Lower than expected sample sizes meant that a comparison of service models in WP2 was not possible. The findings are preliminary. At discharge (T1), significant improvements in mean score on outcome measures, except self-reported functioning, were observed. Further improvements were observed at 6 months post discharge (T2), but these were significant for self-reported functioning only. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with outcomes and resource use at T1. Staff’s views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed that people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence may be inappropriate. Furthermore, staff believed that flexibility in practice (e.g. duration of home visits) should be incorporated into delivery models and adequate provision made for specialist training of staff.
Conclusions
The study contributes to our understanding of reablement, and what the impacts are on outcomes and costs. Staff believe that reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate the factors that have an impact on outcomes, and reabling people with dementia.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Rachel Mann
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Rita Faria
- Centre for Health Economics, University of York, York, UK
| | | | | | - Susan Clarke
- Social Policy Research Unit, University of York, York, UK
| | - Emese Mayhew
- Social Policy Research Unit, University of York, York, UK
| | - Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | | | - Fiona Aspinal
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames, Institute of Epidemiology & Health, University College London, London, UK
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Miller KK, Lin SH, Neville M. From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke. Arch Phys Med Rehabil 2018; 100:1162-1175. [PMID: 30465739 DOI: 10.1016/j.apmr.2018.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.
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Affiliation(s)
- Kristine K Miller
- Department of Physical Therapy, Indiana University, Indianapolis, IN.
| | - Susan H Lin
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marsha Neville
- School of Occupational Therapy, Texas Woman's University, Dallas, TX
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Allen L, John-Baptiste A, Meyer M, Richardson M, Speechley M, Ure D, Markle-Reid M, Teasell R. Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study. Disabil Rehabil 2018; 41:2060-2065. [PMID: 29631453 DOI: 10.1080/09638288.2018.1459879] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a "Usual Care" cohort. Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year. Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = -$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care. Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods. Implications for Rehabilitation Ongoing rehabilitation following stroke is imperative for optimal recovery. Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible. The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.
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Affiliation(s)
- Laura Allen
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Ava John-Baptiste
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Matthew Meyer
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Marina Richardson
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Mark Speechley
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - David Ure
- c St. Joseph's Health Care, Parkwood Institute , London , Canada
| | | | - Robert Teasell
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,c St. Joseph's Health Care, Parkwood Institute , London , Canada.,e Schulich School of Medicine and Dentistry , University of Western Ontario, Physical Medicine and Rehabilitation , London , Canada
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Obembe AO, Goldsmith CH, Simpson LA, Sakakibara BM, Eng JJ. Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions. PLoS One 2018; 13:e0192911. [PMID: 29474391 PMCID: PMC5825050 DOI: 10.1371/journal.pone.0192911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Social support can help to deal with the consequences of neurological conditions and promote functional independence and quality of life. Our aim was to evaluate the impact of neurological conditions on the use of support and health-care services in a population-based sample of community-dwelling adults with neurological conditions. Methods Data were from the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents. Formal and informal support received and out-of-pocket payments were assessed by personal interviews. Logistic regression was used to explore the association between support service utilization and six common neurological conditions (Stroke, Parkinson's disease, Alzheimer's disease/dementias, traumatic brain injury, spinal cord injury and multiple sclerosis) with stroke as the reference category. Results The sample contained 2,410 respondents and equate to an estimated 459,770 when sample weights were used. A larger proportion of people within each of the neurological conditions received informal support than formal support (at least twice as much). Samples with the non-stroke conditions were more likely to receive formal assistance for personal (odds ratios 2.7 to 5.6; P < 0.05) and medical (odds ratios 2.4 to 4.4; P < 0.05) care compared to the stroke group. Also, the non-stroke conditions were more likely to receive informal assistance (odds ratios 2.7 to 17.9; P < 0.05) and less likely to make out-of-pocket payments for rehabilitation therapy (odds ratios 0.2 to 0.3; P < 0.05) than the stroke group. The Alzheimer’s disease/dementia group had the highest proportion who received formal and informal support services. Conclusions Our findings suggest that Canadians with neurological conditions receive more informal assistance than formal assistance. Furthermore, it appears that stroke survivors receive less support services, while those with Alzheimer’s disease/dementia receive the most compared to other adult neurological conditions. Such data can help inform the development of support services in the community.
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Affiliation(s)
- Adebimpe O. Obembe
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Charlie H. Goldsmith
- Adjunct Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Adjunct Professor, Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
| | - Lisa A. Simpson
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, Canada
| | - Brodie M. Sakakibara
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
- * E-mail:
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Walker MF, Thomas SA, Whitehead PJ, Condon L, Fisher RJ, Kontou E, Benford P, Cobley C. Biopsychosocial Intervention for Stroke Carers (BISC): protocol for a feasibility randomised controlled trial (RCT). BMJ Open 2017; 7:e018309. [PMID: 29061630 PMCID: PMC5665302 DOI: 10.1136/bmjopen-2017-018309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Reducing length of hospital stay for stroke survivors often creates a shift in the responsibility of care towards informal carers. Adjustment to the caregiving process is experienced by many carers as overwhelming, complex and demanding and can have a detrimental impact on mental and physical health and well-being. National policy guidelines recommend that carers' needs are considered and addressed; despite this, few interventions have been developed and empirically evaluated. We developed a biopsychosocial intervention in collaboration with carers of stroke survivors. Our aim is to determine whether the intervention can be delivered in a group setting and evaluated using a randomised controlled trial (RCT). METHODS AND ANALYSIS Feasibility RCT and nested qualitative interview study. We aim to recruit up to 40 stroke carers within 1 year of the stroke onset. Carers are randomised to usual care or usual care plus biopsychosocial intervention. Each intervention group will consist of five stroke carers. The intervention will focus on: psychoeducation, psychological adjustment to stroke, strategies for reducing unwanted negative thoughts and emotions and problem-solving strategies. The main outcome is the feasibility of conducting an RCT. Carer outcomes at 6 months include: anxiety and depression, quality of life and carer strain. Data are also collected from stroke survivors at baseline and 6 months including: level of disability, anxiety and depression, and quality of life. ETHICS AND DISSEMINATION Favourable ethical opinion was provided by East Midlands - Nottingham2 Research Ethics Committee (14/EMI/1264). This study will determine whether delivery of the biopsychosocial intervention is feasible and acceptable to stroke carers within a group format. It will also determine whether it is feasible to evaluate the effects of the biopsychosocial intervention in an RCT. We will disseminate our findings through peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN15643456; Pre-results.
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Affiliation(s)
- Marion F Walker
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Shirley A Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Phillip J Whitehead
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Laura Condon
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Rebecca J Fisher
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Eirini Kontou
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Penny Benford
- Division of Rehabilitation and Ageing, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, UK
| | - Christine Cobley
- Department of Clinical Psychology, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
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Ballester BR, Nirme J, Camacho I, Duarte E, Rodríguez S, Cuxart A, Duff A, Verschure PFMJ. Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke. JMIR Serious Games 2017; 5:e15. [PMID: 28784593 PMCID: PMC5565792 DOI: 10.2196/games.6773] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. Objective The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. Methods We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. Conclusions These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. Trial Registration International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1)
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Affiliation(s)
- Belén Rubio Ballester
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Jens Nirme
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Irene Camacho
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Esther Duarte
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Susana Rodríguez
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ampar Cuxart
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Armin Duff
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Paul F M J Verschure
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain.,ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.,Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028, Barcelona, Spain
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Abstract
BACKGROUND People with stroke conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed that offer people in hospital an early discharge with rehabilitation at home (early supported discharge: ESD). OBJECTIVES To establish if, in comparison with conventional care, services that offer people in hospital with stroke a policy of early discharge with rehabilitation provided in the community (ESD) can: 1) accelerate return home, 2) provide equivalent or better patient and carer outcomes, 3) be acceptable satisfactory to patients and carers, and 4) have justifiable resource implications use. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (January 2017), Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 1) in the Cochrane Library (searched January 2017), MEDLINE in Ovid (searched January 2017), Embase in Ovid (searched January 2017), CINAHL in EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to December 2016), and Web of Science (to January 2017). In an effort to identify further published, unpublished, and ongoing trials we searched six trial registries (March 2017). We also performed citation tracking of included studies, checked reference lists of relevant articles, and contacted trialists. SELECTION CRITERIA Randomised controlled trials (RCTs) recruiting stroke patients in hospital to receive either conventional care or any service intervention that has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow-up. Two review authors scrutinised trials, categorised them on their eligibility and extracted data. Where possible we sought standardised data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. We assessed risk of bias for the included trials and used GRADE to assess the quality of the body of evidence. MAIN RESULTS We included 17 trials, recruiting 2422 participants, for which outcome data are currently available. Participants tended to be a selected elderly group of stroke survivors with moderate disability. The ESD group showed reductions in the length of hospital stay equivalent to approximately six days (mean difference (MD) -5.5; 95% confidence interval (CI) -3 to -8 days; P < 0.0001; moderate-grade evidence). The primary outcome was available for 16 trials (2359 participants). Overall, the odds ratios (OR) for the outcome of death or dependency at the end of scheduled follow-up (median 6 months; range 3 to 12) was OR 0.80 (95% CI 0.67 to 0.95, P = 0.01, moderate-grade evidence) which equates to five fewer adverse outcomes per 100 patients receiving ESD. The results for death (16 trials; 2116 participants) and death or requiring institutional care (12 trials; 1664 participants) were OR 1.04 (95% CI 0.77 to 1.40, P = 0.81, moderate-grade evidence) and OR 0.75 (95% CI 0.59 to 0.96, P = 0.02, moderate-grade evidence), respectively. Small improvements were also seen in participants' extended activities of daily living scores (standardised mean difference (SMD) 0.14, 95% CI 0.03 to 0.25, P = 0.01, low-grade evidence) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02, low-grade evidence). We saw no clear differences in participants' activities of daily living scores, patients subjective health status or mood, or the subjective health status, mood or satisfaction with services of carers. We found low-quality evidence that the risk of readmission to hospital was similar in the ESD and conventional care group (OR 1.09, 95% CI 0.79 to 1.51, P = 0.59, low-grade evidence). The evidence for the apparent benefits were weaker at one- and five-year follow-up. Estimated costs from six individual trials ranged from 23% lower to 15% greater for the ESD group in comparison to usual care.In a series of pre-planned analyses, the greatest reductions in death or dependency were seen in the trials evaluating a co-ordinated ESD team with a suggestion of poorer results in those services without a co-ordinated team (subgroup interaction at P = 0.06). Stroke patients with mild to moderate disability at baseline showed greater reductions in death or dependency than those with more severe stroke (subgroup interaction at P = 0.04). AUTHORS' CONCLUSIONS Appropriately resourced ESD services with co-ordinated multidisciplinary team input provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. Results are inconclusive for services without co-ordinated multidisciplinary team input. We observed no adverse impact on the mood or subjective health status of patients or carers, nor on readmission to hospital.
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Affiliation(s)
- Peter Langhorne
- ICAMS, University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Satu Baylan
- Queen Elizabeth University HospitalInstitute of Health and Wellbeing, College of Medical, Veterinary and Life SciencesGlasgowUKG51 4TF
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Gonçalves-Bradley DC, Iliffe S, Doll HA, Broad J, Gladman J, Langhorne P, Richards SH, Shepperd S. Early discharge hospital at home. Cochrane Database Syst Rev 2017; 2017:CD000356. [PMID: 28651296 PMCID: PMC6481686 DOI: 10.1002/14651858.cd000356.pub4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. OBJECTIVES To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. SEARCH METHODS We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. SELECTION CRITERIA Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes. DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. MAIN RESULTS We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI 0.40 to 0.98; N = 574, 4 trials, low-certainty evidence) and might slightly improve patient satisfaction (N = 795, low-certainty evidence). Hospital at home probably reduces hospital length of stay, as moderate-certainty evidence found that people assigned to hospital at home are discharged from the intervention about seven days earlier than people receiving inpatient care (95% CI 10.19 to 3.17 days earlier, N = 528, 4 trials). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people with a mix of medical conditionsEarly discharge hospital at home probably makes little or no difference to mortality (RR 1.07, 95% CI 0.76 to 1.49; N = 1247, 8 trials, moderate-certainty evidence). In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people undergoing elective surgeryThree studies did not report higher rates of mortality with hospital at home compared with inpatient care (data not pooled, N = 856, low-certainty evidence; mainly orthopaedic surgery). Hospital at home may lead to little or no difference in readmission to hospital for people who were mainly recovering from orthopaedic surgery (N = 1229, low-certainty evidence). We could not establish the effects of hospital at home on the risk of living in institutional care, due to a lack of data. The intervention might slightly improve patient satisfaction (N = 1229, low-certainty evidence). People recovering from orthopaedic surgery allocated to early discharge hospital at home were discharged from the intervention on average four days earlier than people allocated to usual inpatient care (4.44 days earlier, 95% CI 6.37 to 2.51 days earlier, , N = 411, 4 trials, moderate-certainty evidence). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence). AUTHORS' CONCLUSIONS Despite increasing interest in the potential of early discharge hospital at home services as a less expensive alternative to inpatient care, this review provides insufficient evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.
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Kusambiza-Kiingi A, Maleka D, Ntsiea V. Stroke survivors' levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Afr J Disabil 2017; 6:296. [PMID: 28730068 PMCID: PMC5502467 DOI: 10.4102/ajod.v6i0.296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/29/2016] [Indexed: 11/05/2022] Open
Abstract
Background Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. Aim To determine stroke survivors’ levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Method This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. Results A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). Conclusion Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services.
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Affiliation(s)
| | - Douglas Maleka
- Department of Health Sciences Education, University of Limpopo, South Africa
| | - Veronica Ntsiea
- Physiotherapy Department, University of the Witwatersrand, South Africa
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Laut J, Porfiri M, Raghavan P. The Present and Future of Robotic Technology in Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016; 4:312-319. [PMID: 28603663 PMCID: PMC5461931 DOI: 10.1007/s40141-016-0139-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Robotic technology designed to assist rehabilitation can potentially increase the efficiency of and accessibility to therapy by assisting therapists to provide consistent training for extended periods of time, and collecting data to assess progress. Automatization of therapy may enable many patients to be treated simultaneously and possibly even remotely, in the comfort of their own homes, through telerehabilitation. The data collected can be used to objectively assess performance and document compliance as well as progress. All of these characteristics can make therapists more efficient in treating larger numbers of patients. Most importantly for the patient, it can increase access to therapy which is often in high demand and rationed severely in today's fiscal climate. In recent years, many consumer grade low-cost and off-the-shelf devices have been adopted for use in therapy sessions and methods for increasing motivation and engagement have been integrated with them. This review paper outlines the effort devoted to the development and integration of robotic technology for rehabilitation.
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Affiliation(s)
- Jeffrey Laut
- New York University Tandon School of Engineering
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Edgar MC, Monsees S, Rhebergen J, Waring J, Van der Star T, Eng JJ, Sakakibara BM. Telerehabilitation in Stroke Recovery: A Survey on Access and Willingness to Use Low-Cost Consumer Technologies. Telemed J E Health 2016; 23:421-429. [PMID: 27705095 DOI: 10.1089/tmj.2016.0129] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background/Introduction: Early telerehabilitation trials with stroke survivors have shown promising results, but there remains a lack of knowledge of what areas of rehabilitation people with stroke are interested and willing to receive using technology. The purpose of this study was to describe the access to low-cost consumer technologies and willingness to use them to receive rehabilitation services among stroke survivors. MATERIALS AND METHODS Participants were included in this survey study if they had a stroke, lived in the community, were 19 years of age or older, and able to understand English. Participants completed a study-specific telerehabilitation survey via phone call, mail, in-person, or online. Descriptive statistics were used to characterize the sample and survey responses. RESULTS One hundred two survey responses were returned, representing a 79.1% response rate. The mean age of this urban (67.3%) and rural (32.7%) sample was 67.6 years. The technologies most commonly owned were as follows: televisions (91%), landline telephones (88.0%), and computers (79.0%). A large proportion of the sample reported an interest to receive assessments (58.4%), training and exercise programs (64.0%), and education (61.4%) via telerehabilitation, however, many were not interested to receive telerehabilitation (∼39%) and believed that the quality of care would be less than in-person rehabilitation (71.0%). CONCLUSIONS The use of consumer technologies for the delivery of rehabilitation services is both feasible and desirable by stroke survivors. Telerehabilitation services at present should augment and not replace in-person rehabilitation. However, in cases where in-person rehabilitation is neither accessible nor possible, telerehabilitation could serve as an acceptable alternative and is a key area for future research.
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Affiliation(s)
- Mary C Edgar
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - Sarah Monsees
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - Josina Rhebergen
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - Jennifer Waring
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - Todd Van der Star
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada
| | - Janice J Eng
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada .,2 Rehabilitation Research Program, Vancouver Coastal Health Research Institute , Vancouver, Canada
| | - Brodie M Sakakibara
- 1 Department of Physical Therapy, University of British Columbia , Vancouver, Canada .,2 Rehabilitation Research Program, Vancouver Coastal Health Research Institute , Vancouver, Canada .,3 Faculty of Health Sciences, Simon Fraser University , Vancouver, Canada
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Weinrich M, Good DC, Reding M, Roth EJ, Cifu DX, Silver KH, Craik RL, Magaziner J, Terrin M, Schwartz M, Gerber L. Timing, Intensity, and Duration of Rehabilitation for Hip Fracture and Stroke: Report of a Workshop at the National Center for Medical Rehabilitation Research. Neurorehabil Neural Repair 2016; 18:12-28. [PMID: 15035960 DOI: 10.1177/0888439003262041] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of rehabilitation for acute stroke and hip fracture. Participants concentrated on methodological issues facing investigators and suggested priorities for future research in this area.
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Abstract
Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of ‘best practice’. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI–both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.
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Abstract
Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.
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Affiliation(s)
- Helen M. Dewey
- National Stroke Research Institute, Austin Health, Melbourne, Australia
- Neurology Department, Austin Health, Melbourne, Australia
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Australia
| | - Lisa J. Sherry
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Australia
- Royal Talbot Rehabilitation Centre, Austin Health, Melbourne, Australia
| | - Janice M. Collier
- National Stroke Research Institute, Austin Health, Melbourne, Australia
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Akhavan Hejazi SM, Mazlan M, Abdullah SJF, Engkasan JP. Cost of post-stroke outpatient care in Malaysia. Singapore Med J 2016; 56:116-9. [PMID: 25715857 DOI: 10.11622/smedj.2015025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients. METHODS This was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale. RESULTS This study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001). CONCLUSION Post-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.
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Affiliation(s)
| | | | | | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Nkoke C, Luchuo EB. Post-stroke care: an alternative model to reduce stroke related morbidity in sub-Saharan Africa. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:238. [PMID: 26539455 DOI: 10.3978/j.issn.2305-5839.2015.09.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Stroke is a leading cause of death and disability in adults in sub-Saharan Africa (SSA). Despite its considerable burden, there has been limited progress to properly cater for and rehabilitate stroke survivors. Scarcity of rehabilitation services and grossly inadequate skilled personnel for post stroke care are distressing realities for stroke victims in SSA. There is growing evidence suggesting that home-based rehabilitation for stroke can have functional outcomes similar to patients who receive inpatient neuro-rehabilitation. The acute phase of treatment during hospitalization could be an opportunity to educate families and caregivers on how to care for stroke victims at home and provide home-based rehabilitation and care tailored to their disability. Interventions to vulgarize home-based post-stroke care could be more acceptable, affordable and accessible for victims and families. This could go a long way to palliate to the scarcity of rehabilitation services and reduce stroke related morbidity. We suggest that further research be carried out to ascertain the feasibility of this model in SSA settings, with greater emphasis on the cost effectiveness and sustainability arms of such an intervention.
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Affiliation(s)
- Clovis Nkoke
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde 1, Cameroon ; 2 Department of Military Health, Ministry of Defense, Cameroon and Centre for Population Studies and Health Promotion, Yaounde, Cameroon
| | - Engelbert Bain Luchuo
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde 1, Cameroon ; 2 Department of Military Health, Ministry of Defense, Cameroon and Centre for Population Studies and Health Promotion, Yaounde, Cameroon
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Abstract
Weight loss continues for extended time post-bariatric surgery; thus, discharge destination is an important factor to consider when examining outcomes of surgery. The Agency for Healthcare Research and Quality State Inpatient Database was utilized to identify patients with bariatric surgery and to determine factors associated with and predictive of home discharge. Patients that were discharged home had shorter length of stays, lower total hospital costs, fewer chronic conditions, and lower readmission rates. Factors predictive of discharge were identified. Being discharged home could be associated with characteristics vital to patient's long-term weight loss. It is imperative to focus on factors predictive of home discharge in order to reap the most beneficial outcomes of surgery.
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Affiliation(s)
- Emily E Johnson
- Department of Health Sciences and Research, Medical University of South Carolina, 77 President Street, Charleston, SC, 29425, USA,
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Faux S, Ahmat J, Bailey J, Kesper D, Crotty M, Pollack M, Olver J. Stroke Rehab Down Under: Can Rupert Murdoch, Crocodile Dundee, and an Aboriginal Elder Expect the Same Services and Care? Top Stroke Rehabil 2015. [DOI: 10.1310/tsr1601-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial. BMC Health Serv Res 2015; 15:165. [PMID: 25927870 PMCID: PMC4438580 DOI: 10.1186/s12913-015-0822-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/26/2015] [Indexed: 11/28/2022] Open
Abstract
Background Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs. Methods Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence. Results A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI −4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention. Conclusions From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community. Trial registration Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0822-3) contains supplementary material, which is available to authorized users.
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Teasell RW, Foley NC, Bhogal SK, Speechley MR. Early Supported Discharge in Stroke Rehabilitation. Top Stroke Rehabil 2015; 10:19-33. [PMID: 13680516 DOI: 10.1310/qlfn-m4mx-xemm-2ycq] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A systematic review of the randomized controlled trials published from 1970-2002 was conducted to assess the effectiveness of early supported discharge programs in the context of stroke rehabilitation. Ten studies, including 1,286 patients, were selected for detailed review. The methodological quality of the studies was assessed using the PEDro Scale. The outcome assessed included functional outcomes, cost analysis, and length of hospital stay. Although the majority of studies reported no statistically significant differences in functional outcomes between the two groups, there was a reduction in hospital stays for patients receiving home-based therapy. These results suggest that patients with milder strokes who receive home-based therapies have similar functional outcomes to patients who receive traditional inpatient rehabilitation.
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Affiliation(s)
- Robert W Teasell
- Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Community Stroke Rehabilitation Teams: Providing Home-Based Stroke Rehabilitation in Ontario, Canada. Can J Neurol Sci 2014; 41:697-703. [DOI: 10.1017/cjn.2014.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBackground: Community stroke rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to stroke rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. Methods: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. Results: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5±13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p=0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p<0.001), Functional Independence Measure (p<0.001), Reintegration to Normal Living Index (p=0.01), Bakas Caregiver Outcomes Scale (p<0.001), and Caregiver Assistance and Confidence Scale assistance subscale (p=0.005). Significant gains were observed on the strength, communication, activities of daily living, social participation, memory, and physical domains of the Stroke Impact Scale (all p<0.001). These improvements were maintained at the 6-month follow-up. No significant improvements were observed upon discharge on the memory and thinking domain of the Stroke Impact Scale; however, there was a significant improvement between admission and follow-up (p=0.002). All significant improvements were maintained at the 6-month follow-up. Conclusions: Results indicate that the community stroke rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, stroke-specific multidisciplinary rehabilitation program should be considered when accessibility to outpatient services is limited.
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Wang TC, Tsai AC, Wang JY, Lin YT, Lin KL, Chen JJ, Lin BY, Lin TC. Caregiver-Mediated Intervention Can Improve Physical Functional Recovery of Patients With Chronic Stroke. Neurorehabil Neural Repair 2014; 29:3-12. [DOI: 10.1177/1545968314532030] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Purpose. Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve physical functioning and social participation in these patients. Methods. A single-blind, randomized, controlled 12-week trial conducted with 51 patients from 3 hospitals in Taiwan who had chronic stroke (>6 months; Brunnstrom recovery stages III-V). Patients and their caregivers in the intervention arm (n = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (n = 26) received visits from the therapist without intervention. All were evaluated for physical recovery through the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Barthel Index at baseline and endpoint. Caregivers were evaluated with the Caregiver Burden Scale. Results were analyzed through Mann-Whitney U test. Results. CHI significantly improved scores of the Stroke Impact Scale: strength (control vs intervention, respectively: 1.4 vs 15.5; P = .002), mobility (–0.5 vs 13.7; P < .001), composite physical (–0.7 vs 11.2; P < .001), and general recovery domain (0.2 vs 17.4; P < .001). CHI also significantly improved free-walking velocity (–1.4 vs 7.5 cm/s; P = .006), 6-minute walk distance (–10.5 vs 15.8 m; P = .003), Berg Balance Scale score (–0.8 vs 4.5; P = .006), and Barthel Index score (0.6 vs 7.2; P = .008). CHI did not significantly increase caregiver burden at endpoint. Conclusion. CHI can improve physical functional recovery and, possibly, social participation in patients with chronic stroke.
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Affiliation(s)
- Tzu-Chi Wang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Physical Therapy, Tzu Hui Institute of Technology, Pingtung, Taiwan
| | - Alan C. Tsai
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Health Services Management, School of Public Health, China Medical University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Yu-Te Lin
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jiun Jiang Chen
- Department of Rehabilitation, Kaohsiung Municipal Min-sheng Hospital, Kaohsiung, Taiwan
| | - Bei Yi Lin
- Department of Rehabilitation, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Tai Ching Lin
- Department of Rehabilitation, St Joseph Hospital, Kaohsiung, Taiwan
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Ghostman: augmented reality application for telerehabilitation and remote instruction of a novel motor skill. BIOMED RESEARCH INTERNATIONAL 2014; 2014:646347. [PMID: 24829910 PMCID: PMC4009317 DOI: 10.1155/2014/646347] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022]
Abstract
This paper describes a pilot study using a prototype telerehabilitation system (Ghostman). Ghostman is a visual augmentation system designed to allow a physical therapist and patient to inhabit each other's viewpoint in an augmented real-world environment. This allows the therapist to deliver instruction remotely and observe performance of a motor skill through the patient's point of view. In a pilot study, we investigated the efficacy of Ghostman by using it to teach participants to use chopsticks. Participants were randomized to a single training session, receiving either Ghostman or face-to-face instructions by the same skilled instructor. Learning was assessed by measuring retention of skills at 24-hour and 7-day post instruction. As hypothesised, there were no differences in reduction of error or time to completion between participants using Ghostman compared to those receiving face-to-face instruction. These initial results in a healthy population are promising and demonstrate the potential application of this technology to patients requiring learning or relearning of motor skills as may be required following a stroke or brain injury.
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Brusco NK, Taylor NF, Watts JJ, Shields N. Economic Evaluation of Adult Rehabilitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in a Variety of Settings. Arch Phys Med Rehabil 2014; 95:94-116.e4. [DOI: 10.1016/j.apmr.2013.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Von Koch L, Holmqvist LW. Early Supported Discharge and Continued Rehabilitation At Home After Stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.2001.6.2.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Olaleye OA, Hamzat TK, Owolabi MO. Stroke rehabilitation: should physiotherapy intervention be provided at a primary health care centre or the patients' place of domicile? Disabil Rehabil 2013; 36:49-54. [PMID: 23594059 DOI: 10.3109/09638288.2013.777804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This randomized controlled trial compared the outcomes of physiotherapy intervention on selected indices of recovery for stroke survivors treated at a primary health centre group (PHCG) with those treated in their respective places of domicile group (DG). METHODS Participants were 52 individuals comprising 24 males and 28 females who had suffered a stroke and were recently discharged from two inpatient health facilities in Ibadan, Nigeria. They were randomly assigned into either the PHCG (n = 25) or DG (n = 27) and treated twice weekly for 10 consecutive weeks using a physiotherapy intervention protocol comprising a battery of task-specific exercises. The outcomes measured were motor function, balance and handicap assessed using the modified motor assessment scale (MMAS), short-form postural assessment scale for stroke (SF-PASS) and reintegration to normal living index (RNLI), respectively, as well as walking speed which was assessed using a standard technique. RESULTS Between-group comparison using the General Linear Model revealed no statistically significant difference in both the pre- and post-intervention scores of the two groups on the MMAS, SF-PASS, RNLI and walking speed in both PHCG and DG (p > 0.05). However, within-group comparison yielded a statistically significant difference in each of the indices of stroke recovery measured across the 10-week period in both groups. CONCLUSION Physiotherapy intervention at the primary health care centre and respective homes of stroke survivors similarly improved clinical outcomes. Treatment at any of these locations may enhance access to physiotherapy after stroke in a low-income community like Nigeria. IMPLICATIONS FOR REHABILITATION Physiotherapy protocol comprising 10-week task-specific battery of exercises produced significant improvement in walking speed, balance, motor function and community reintegration of stroke survivors. Physiotherapy post-stroke can be provided at either a primary health centre or the domicile of the individual. In a low-income country like Nigeria, this will enhance access to this important service.
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Craig LE, Wu O, Bernhardt J, Langhorne P. Approaches to economic evaluations of stroke rehabilitation. Int J Stroke 2013; 9:88-100. [PMID: 23521855 DOI: 10.1111/ijs.12041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Louise E Craig
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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41
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Economic comparison between Hospital at Home and traditional hospitalization using a simulation‐based approach. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2013. [DOI: 10.1108/17410391311289596] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Mas MÀ, Inzitari M. A Critical Review of Early Supported Discharge for Stroke Patients: From Evidence to Implementation into Practice. Int J Stroke 2012; 10:7-12. [DOI: 10.1111/j.1747-4949.2012.00950.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
Abstract
After an acute stroke, a multidimensional approach based on multidisciplinary work and rehabilitation is required in order to promote functional independence and social reinsertion and to maintain medical stability. These activities are usually developed in the hospital setting as a continuum of the acute phase, but hospitalization is resource consuming and resources are limited. Early Support Discharge strategies base postacute care and rehabilitation at home after an early discharge planning and represent possible alternatives to conventional hospitalization. Recent evidence suggests that Early Supported Discharge might be superior to hospitalization from both the clinical-functional and the economic viewpoints. Moreover, home-based rehabilitation might potentiate important determinants of effectiveness, such as patient's motivation and goal-directed rehabilitation. However, hitherto produced evidence and recommendations show a number of limitations related to the organization models, the inclusion/exclusion criteria, and the questionable applicability of results to any healthcare setting worldwide. In this article, we critically review different methodological and organizational aspects of the available studies. For example in the definition of the target population, based mainly on residual disability and medical stability, we suggest that other relevant aspects, such as premorbid functional status, cognitive function, and previous institutionalization, should be better defined. Focusing on the outcomes, we suggest that, besides strong outcomes such as global functioning, surrogate outcomes, such as physical function, could help to refine the specific interventions. Finally, considering that the majority of studies were conducted in northern Europe, further studies are needed to test the implementation of Early Supported Discharge in different regions.
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Affiliation(s)
- Miquel Àngel Mas
- Department of Geriatric Medicine and Palliative Care, Badalona Serveis Assistencials, Badalona, Catalonia, Spain
- Universitat Autònoma Barcelona, Catalonia, Spain
| | - Marco Inzitari
- Universitat Autònoma Barcelona, Catalonia, Spain
- Pere Virgili Hospital, Barcelona, Catalonia, Spain
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Lackie R, Bisset L. The power of home rehabilitation: a single case study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.12.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This single case study reports on an 81-year-old woman who underwent a rehabilitation programme initially in a hospital inpatient setting, then in a home setting. There was a clinically significant improvement in functional outcomes following the home-based rehabilitation, but not following the inpatient rehabilitation programme. This case study illustrates that empowerment of the patient may sometimes be greater in the home environment, possibly due to different roles taken by the patient and therapist in the home compared with roles taken in a hospital environment. This patient reported feelings of being in more control at home, with greater capacity to set their own goals, and improved feelings of motivation with this increased level of engagement. This increased empowerment can lead to more effective outcomes for patients undergoing rehabilitation in the home, and must be considered as an ideal rehabilitation environment for some patients.
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Affiliation(s)
- Rebecca Lackie
- Transition Care Program, Gold Coast Hospital and Health Service, Australia and
| | - Leanne Bisset
- School of Rehabilitation Science, Griffith University, Gold Coast Campus, Australia
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Economic evidence on integrated care for stroke patients; a systematic review. Int J Integr Care 2012; 12:e193. [PMID: 23593053 PMCID: PMC3601509 DOI: 10.5334/ijic.847] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 11/20/2022] Open
Abstract
Introduction Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. Methods A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized. Results Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; one year or less. The comparators and the scope of included costs varied between studies. Conclusions Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects.
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Abstract
BACKGROUND Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)). OBJECTIVES To establish the effects and costs of ESD services compared with conventional services. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (January 2012) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group, MEDLINE (2008 to 7 February 2012), EMBASE (2008 to 7 February 2012) and CINAHL (1982 to 7 February 2012). In an effort to identify further published, unpublished and ongoing trials we searched 17 trial registers (February 2012), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists. SELECTION CRITERIA Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow-up. Two review authors scrutinised trials and categorised them on their eligibility. We then sought standardised individual patient data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not. MAIN RESULTS Outcome data are currently available for 14 trials (1957 patients). Patients tended to be a selected elderly group with moderate disability. The ESD group showed significant reductions (P < 0.0001) in the length of hospital stay equivalent to approximately seven days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow-up were OR 0.91 (95% CI 0.67 to 1.25, P = 0.58), OR 0.78 (95% CI 0.61 to 1.00, P = 0.05) and OR 0.80 (95% CI 0.67 to 0.97, P = 0.02) respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild to moderate disability. Improvements were also seen in patients' extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers' subjective health status, mood or satisfaction with services. The apparent benefits were no longer statistically significant at five-year follow-up. AUTHORS' CONCLUSIONS Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. We observed no adverse impact on the mood or subjective health status of patients or carers.
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Affiliation(s)
- Patricia Fearon
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK
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Home-based nutritional therapy. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Khiaocharoen O, Pannarunothai S, Riewpaiboon W, Ingsrisawang L, Teerawattananon Y. Economic Evaluation of Rehabilitation Services for Inpatients with Stroke in Thailand: A Prospective Cohort Study. Value Health Reg Issues 2012; 1:29-35. [DOI: 10.1016/j.vhri.2012.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Evidence-Based Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage English Edition. Neurol Med Chir (Tokyo) 2012; 52:355-429. [DOI: 10.2176/nmc.52.355] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVE To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. METHODS Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. RESULTS A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). CONCLUSIONS A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.
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