Factors affecting functional outcome after stroke: A critical review of rehabilitation interventions

Cifu, David X.; Stewart, Deborah G.

doi:10.1016/s0003-9993(99)90101-6

Cited by 194 publications

(118 citation statements)

References 52 publications

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“…18 Only 30% of patients improved significantly after 6 months of rehabilitation when assessed using the Minimum Data set for Home Care which describes activities of daily living (ADLs). Age (increasing) Gitlin et al 19 Landi et al 15 Kaambwa et al 16 Comans et al 20 Pereira et al 17 Fjaertoft et al 37 Fusco et al 18 Allen et al 42 Mallinson et al 39 Sex (female) Gitlin et al 19 Landi et al 15 Comans et al 20 Kaambwa et al 16 Pereira et al 17 Fusco et al 18 Allen et al 42 Fjaertoft et al 37 Mallinson et al 39 Living alone Kaambwa et al 16 Fjaertoft et al 37 Kaambwa et al 16 Comans et al 20 Sensory impairment…”

Section: Which Patients Are Most or Least Likely To Benefit From Intementioning

confidence: 99%

“…While these studies are not directly comparable, because they consider a more acutely ill population, they identified several variables of importance to predicting patient outcomes, such as age, gender, living alone, admission route, admission status, functional status, reason for admission, and the services received. Several of these variables are mirrored in rehabilitation research (19). Other predictors of rehabilitation outcomes in older patients include lower admission scores on a range of dependency measures (7,8,20).…”

Section: Introductionmentioning

confidence: 99%

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Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.

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Section: Which Patients Are Most or Least Likely To Benefit From Intementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Ariss

Enderby

Smith

et al. 2015

Health Services and Delivery Research

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“…Lastly, many assessments can take a long time to complete (e.g., Behavioral Inattention Test [28]). In our experience, this leads clinicians to either delay the delivery of treatment in favor of a lengthy assessment (in some cases as long as 5 days), despite evidence on the timing and importance of early rehabilitation treatment [29][30][31][32][33], or abandon assessment altogether.…”

Section: Traditional Approachesmentioning

confidence: 99%

“…Studies in animal models have demonstrated the importance of rehabilitation intervention within the first week following stroke to maximize neurological recovery [29]. In humans, earlier delivery of rehabilitation has been associated with better functional recovery [29][30][31][32][33][88][89]. The duration of therapy is a topic of some debate because traditional belief has been that the majority of neurologic recovery occurs within the first 4 months following stroke [90].…”

Section: Better Treatment Planmentioning

confidence: 99%

Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy

Scott¹,

Dukelow²

2011

JRRD

167

118

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Abstract-Robotic technologies have profoundly affected the identification of fundamental properties of brain function. This success is attributable to robots being able to control the position of or forces applied to limbs, and their inherent ability to easily, objectively, and reliably quantify sensorimotor behavior. Our general hypothesis is that these same attributes make robotic technologies ideal for clinically assessing sensory, motor, and cognitive impairments in stroke and other neurological disorders. Further, they provide opportunities for novel therapeutic strategies. The present opinionated review describes how robotic technologies combined with virtual/augmented reality systems can support a broad range of behavioral tasks to objectively quantify brain function. This information could potentially be used to provide more accurate diagnostic and prognostic information than is available from current clinical assessment techniques. The review also highlights the potential benefits of robots to provide upper-limb therapy. Although the capital cost of these technologies is substantial, it pales in comparison with the potential cost reductions to the overall healthcare system that improved assessment and therapeutic interventions offer.

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“…Several studies established an association between a lower rate of functional recovery and delayed therapy initiation in neurological conditions, and evidence from human studies has shown that intensive rehabilitation should focus on the acute stroke stage [8][9]. The Department of Veterans Affairs/Department of Defense guidelines for stroke rehabilitation recommend that rehabilitation be started as early as possible [9][10][11][12][13][14]; however, in none of these reports did patients start rehabilitation within 10 days.…”

Section: Introductionmentioning

confidence: 99%

Effects of intensive gait-oriented physiotherapy during early acute phase of stroke

Peurala

Airaksinen²,

Jäkälä³

et al. 2007

JRRD

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Abstract-We assessed the effects and strenuousness of intensive gait-oriented inpatient rehabilitation initiated very early after stroke. Therapy content and interrater reliability of the assessments were also analyzed. Of 22 patients, 19 (average 8.0 d poststroke) completed the study. Before rehabilitation, 13 patients were unable to walk or needed two assistants to walk and 6 patients needed one assistant. Patients spent a daily maximum of 1 h therapy time to obtain 20 min of walking. Additional physiotherapy was also provided during the 3 wk therapy period. Seven structured motor tests were recorded before and after rehabilitation and at 6 months postrehabilitation, and perceived exertion was followed during physiotherapy. After rehabilitation, 16 patients could walk unassisted and 3 needed one assistant to walk. Mean +/-standard deviation exercise walking distance was 10,784 +/-4,446 m and exercise was ranked as slightly strenuous. After 3 wk, the patients' 10 m walking time, ankle spasticity, lower-limb muscle force, and motor scale scores improved (p < 0.05). The early intensive rehabilitation was well tolerated and only three patients dropped out. Improved motor abilities were seen in all stroke patients.Clinical Trial Registration: ClinicalTrials.gov; Gait Trainer vs Traditional Physiotherapy in Acute Stroke, NCT00307762; .

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Factors affecting functional outcome after stroke: A critical review of rehabilitation interventions

Cited by 194 publications

References 52 publications

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy

Effects of intensive gait-oriented physiotherapy during early acute phase of stroke

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