Feasibility of an integrated multidisciplinary geriatric rehabilitation programme for older stroke patients: a process evaluation

Abstract

Background: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.Methods: In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.Results: A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.Conclusion: This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients. Trial registration: International Standard Randomized Controlled Trial Register Number (ISRCTN62286281), and The Dutch Trial Register (NTR2412).

Effectiveness of An Integrated Multidisciplinary Geriatric Rehabilitation Programme for Older Persons with Stroke: A Multicentre Randomised Controlled Trial

“…In addition the training of care professionals in conducting the programme could be improved. However, despite this, the majority of patients, informal caregivers and care professionals indicated the bene cial aspects of the programme 25 .…”

“…The lack of effect of the programme on daily activity and most secondary outcome measures might be explained by several reasons. First, the process evaluation which was performed alongside the trial, revealed that part of patients and informal caregivers did not receive all key elements of the programme 25 . Although almost all patients formulated rehabilitation goals, the GAS method was only used among two thirds of the patients.…”

“…In addition, the percentage of therapy sessions performed in the patients' home environment was lower than planned, and only about a quarter of the patients and informal caregivers attended the education sessions. Furthermore, the self-management training was considered by the care professionals as rather complex and di cult to apply for frail older persons, because it was complicated for the patients to develop and carry out action plans by themselves 25 . As it is widely recognised that in complex interventions often not all aspects of the intervention are completely performed according to protocol and that adaptation to local circumstances may be necessary 26 , it is important to improve the feasibility of the integrated programme by tailoring the goal attainment scaling, self-management training and education sessions more optimally to the population of frail older stroke patients 25 .…”

Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial

“…The lack of effect of the programme on daily activity and most secondary outcome measures might be explained by several reasons. First, the process evaluation which was performed alongside the trial, revealed that part of patients and informal caregivers did not receive all key elements of the programme 27 . Although almost all patients formulated rehabilitation goals, the GAS method was only used among two thirds of the patients.…”

“…In addition, the percentage of therapy sessions performed in the patients' home environment was lower than planned, and only about a quarter of the patients and informal caregivers attended the education sessions. Furthermore, the self-management training was considered by the care professionals as rather complex and di cult to apply for frail older persons, because it was complicated for the patients to develop and carry out action plans by themselves 27 . As it is widely recognised that in complex interventions often not all aspects of the intervention are completely performed according to protocol and that adaptation to local circumstances may be necessary 28 , it is important to improve the feasibility of the integrated programme by tailoring the goal attainment scaling, self-management training and education sessions more optimally to the population of frail older stroke patients 27 .…”