Functional Outcomes, Effectiveness and Efficiency of Stroke Rehabilitation Services in Ramathibodi Hospital: A Prospective Descriptive Study
Keywords:activities of daily living, effectiveness, efficiency, rehabilitation outcome, stroke
Objectives: To study functional outcomes, effectiveness and efficiency of stroke rehabilitation services.
Study design: Prospective descriptive study.
Setting: Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Subjects: Seventy-seven acute stroke patients who were consulted to the Rehabilitation Medicine Department from February to May 2016.
Methods: The patients’ demographic data, Barthel Index (BI), swallowing, communication and cognitive impairments, and the type of rehabilitation services (home-based, outpatient-based and inpatient-based) were recorded and their association with functional recovery was assessed. Rehabilitation effectiveness was measured based on BI gain between the initial and the 12-week follow-up. An inpatient rehabilitation efficiency index was calculated and reported as BI gain per day while in rehabilitation.
Results: Eleven of the patients had an initial BI score of 100. Of the 56 patients having an initial BI ≤ 75, a total of 39, 11, and 6 patients had home-based, outpatient-based and inpatient-based rehabilitation programs, respectively. The levels of mean BI gain (SD) at the 12-week follow-up for those programs were 14.7 (18.6), 25.9 (13.0), 39.2 (10.7), respectively. The mean rehabilitation efficiency index was a gain in BI score of 2.1 points per day. Of the 10 patients with BI between 75 and 99, 9 received home-based rehabilitation and 1 had an inpatient-based rehabilitation program; all had a BI score at the 12-week follow-up of ≥ 95. Among those with dysphagia, recovery of the swallowing function at the 12-week follow-up was found in 30.8% of the patients, but no recovery was found in patients with cognitive impairment.
Conclusions: In moderately to severely disabled stroke patients (BI ≤ 75), inpatient-based rehabilitation is more effective based on BI score gains than either outpatient- or home-based rehabilitation. Patients with mild disability (initial BI > 75) had BI scores ≥ 95 at the 12-week follow-up regardless of the type of rehabilitation provided. The swallowing impairment recovered in one-third of the patients, although cognitive impairment remained.
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