مقاله انگلیسی رایگان در مورد اثربخشی توانبخشی سکته مغزی – الزویر 2020

Background and aim: Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways, including starting time, duration, and frequency of each therapy. In addition, many rehabilitation wards have a standing policy to reduce length of stay (LOS) due to economic considerations. This study aimed to compare the effectiveness and efficiency between intensive and nonintensive rehabilitation protocol for stroke patients. Methods: This prospective, multicenter cohort study was conducted among stroke patients who admitted to rehabilitation wards at 14 centers. All participants received either intensive or non-intensive rehabilitation program. Barthel Index (BI) at admission (BIad), BI at discharge (BIdc), and LOS were recorded. The effectiveness was difference in BIdc and BIad score (DBI), and the efficiency was DBI divided by LOS (DBI/LOS). Results: Seven hundred and eighty stroke patients were included. Mean age was 61.9 § 13.3 years, and 59.7% were male. The majority of patients (79.5%) were admitted for intensive rehabilitation. Effectiveness and efficiency were significantly higher in the intensive group than in the nonintensive group (4.5 § 3.4 versus 2.6 § 3.2 and .24 § .30 versus .18 § .33, respectively). LOS, intensive rehabilitation, and quality of life were significantly positively correlated with effectiveness; whereas, age, onset to admission interval (OAI), and BIad were significantly negatively correlated with the effectiveness of stroke rehabilitation. Conclusions: Stroke patients admitted for intensive rehabilitation had better effectiveness and efficiency than those admitted for non-intensive rehabilitation. Younger patients with shorter OAI, lower BIad, and longer LOS realized significantly enhanced effectiveness.

Introduction

Stroke is one of the leading causes of death, physical disability, and economic burden.1,2 Most stroke survivors have enduring motor disability, which often results in activity limitation and participation restriction.3 Approximately 40% of stroke patients were discharged to inpatient rehabilitation services.4 Well-organized postacute care with interdisciplinary rehabilitation would help to improve the ability of stroke survivors.5,6 Rehabilitation programs are designed on a patient-to-patient basis according to each patient’s level of disability and learning ability. Although there are fundamental principles of rehabilitation for each type of disability, rehabilitation protocols can vary from center to center. Stroke recovery outcome depends on many factors, including age, severity of stroke, comorbidity, cognitive function, duration of disease, and family support.7,8 Rehabilitation service, which provides an effective rehabilitation program using organized and accepted practice guidelines, is one of the factors that contributes to good functional recovery in stroke survivors.2 There are currently many types of rehabilitation service available, including very early rehabilitation, early intensive rehabilitation, extended rehabilitation service, and home-based rehabilitation. Many studies have been conducted to evaluate the effectiveness of rehabilitation after stroke. Previous studies reported that early mobilization of acute stroke patients reduces complications related to immobility and decreases hospital length of stay.9,10 Biernaskie, et al reported that early rehabilitation after stroke enhances brain recovery, but that this effect declines over time.