The result of the beginning of physical therapy in different period and increasing of Barthel index in patients with acute ischemic stroke

Abstract

Objective : To study change of average Barthel index score at the first date, discharge date and the third month in patients with acute ischemic stroke who were performed physical therapy in different period.

Materials and methods : This study was a prognostic outcome research, data were collected by prospective cohort in 120 patients with acute ischemic stroke who were admitted in Nakhonphanom hospital between October 2016 to May 2017. All patients were divided in 3 groups, the first group patients were started physical therapy within 24 hours after admission (n=69), the second group patients were started physical therapy between 24-48 hours (n=34) and the third group patients were started physical therapy after 48 hours (n=17). The Barthel index was evaluated 3 times, the first date after admission, discharged date and the third month follow up. The data were analyzed by analysis of variance for group comparison and exact probability test, Bonferroni adjusted Wald test was used to adjust different initial characters. Analyzed vary of Barthel index score by multi-level multivariable regression.

Results : The 3 groups had different initial Barthel index score. Modified ranking scale, times of physical therapy, passive movement and home program teaching were different. After adjust the difference, change of Barthel index score in 3 months of the patients who started physical therapy in 24-48 hours and the patients who started physical therapy after 48 hours were not different, but Barthel index score in the patients who started physical therapy before 24 hours was changed least.

Conclusion : The patients with acute ischemic stroke who started physical therapy before 24 hours had Barthel index increased at 3 months, not more than other groups who started physical therapy after that. Starting initial physical therapy (before 24 hours) does not increase Barthel index than start physical therapy after 24 hours. Therefore, physical therapy at initial period is unnecessary but likely start within 24-48 hours or after that. This study has limitations in randomizing the groups. A small and unequal number of patients studied may not have a clear conclusion. Therefore, additional studies may be conducted in patients with similar characteristics. Increase the number of patients and are randomly divided into groups to have equal numbers