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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
European Journal of Physical and Rehabilitation Medicine 2017 Apr 14
Copyright © 2017 EDIZIONI MINERVA MEDICA
Factors enhancing activities of daily living after stroke in specialized rehabilitation. An observational multicenter study within the Sunnaas International Network
Birgitta LANGHAMMER 1, 3 ✉, Katharina S. SUNNERHAGEN 2, Åsa LUNDGREN-NILSSON 2, Susanne SÄLLSTRÖM 3, Frank BECKER 3, 4, Johan K. STANGHELLE 3, 4
1 Faculty of Health, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; 2 Faculty of Medicine, Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden; 3 Research Department, Sunnaas Rehabilitation Hospital, Oslo, Norway; 4 Faculty of Medicine, University of Oslo, Oslo, Norway
BACKGROUND: Stroke may lead to serious, long-term disability. Consequently, many individuals with stroke will be in need of rehabilitation, and some of specialized rehabilitation. The content and organization of rehabilitation vary within and between countries, reflecting the preferences, customs, traditions, and values of a society or community, that may have an impact on outcomes.
AIM: The main aim of the present study was to evaluate the influence of team models in specialized rehabilitation on outcomes as measured by stroke patients’ performance in ADL, at a standardized time and at discharge in the various specialized rehabilitation clinics. Secondary aims were to identify explanatory factors for possible differences in ADL changes at standardized time points.
DESIGN: A prospective descriptive cross-sectional explorative, multicentre study.
SETTING: Specialized rehabilitation clinics in Norway, China, the United States, Russia, Israel, Palestine, and Sweden, in total nine clinics.
POPULATION: Persons with stroke.
METHODS: Outcomes measures were the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS), both on admission and at discharge from the inpatient rehabilitation unit, and Barthel Index (BI) or alternatively Functional Independence Measure (FIM), on admittance, 18–22 days into rehabilitation, at discharge, and at 6 and 12 months after discharge.
RESULTS: In total 230 persons with stroke from nine clinics were recruited. There were significant differences in change scores of ADL from admittance to standardized time point 18–22 days into rehabilitation, (p<0.001, r2= 0.19) and when controlled for baseline NIHSS and mRS (p<0.001, r2 = 0.18; p=0.01, r2 = 0.9 respectively). Analysis divided into intra-, multi- and interdisciplinary models showed significant differences at 18–22 days (p=0.02) and at discharge (p<0.001), indicating a more favourable outcome in ADL with the multi- disciplinary model. The linear regression analysis explained 55 % of the changes in ADL (R2= 0.55) at the standardized time point and 48% (R2 = 0.48) at discharge. Main explanatory factors were disability (mRS) and severity (NIHSS), team models, hours in therapy, and location at discharge. ADL was maintained for the majority of participants at 6 and 12 months post discharge. The correlations mRS / ADL (r=-0.68, p<0.0001), NIHSS / ADL (r=-0.55, p<0.0001) and NIHSS / mRS (r=0.46, p<0.0001) disclosed medium to large associations at 18-22 days into rehabilitation.
CONCLUSIONS: The study indicates that the organisation of services in specialized rehabilitation after stroke has a major impact on improvement of ADL outcomes. Main positive predictive factors were models of teamwork, with the multidisciplinary model as most beneficial, and concentrated hours of therapy. Negative predictors were the level of baseline severity and disability post stroke.
CLINICAL REHABILITATION IMPACT: The results indicate that organization of services should be at target to optimize patients’ outcomes in rehabilitation. Furthermore, that concentrated hour’s related to specific goals in therapy are preferable to optimize functional recovery.
KEY WORDS: Activities of daily living - Intra-disciplinary – Interdisciplinary – Multidisciplinary – Stroke - Specialized rehabilitation - Team model