New rehabilitation models for neurologic inpatients in Brazil

Abstract

Purpose: To describe the effects of a rehabilitation program in a neurological inpatient unit in terms of independence for activities of daily living and return to work. Method: Retrospective study with 148 adults with stroke, traumatic brain injury (TBI), spinal cord injury, and Guillain–Barré syndrome admitted as rehabilitation inpatients within a 1-year period for hospitalization at the Instituto de Reabilitação Lucy Montoro, Brazil. According to their diagnostic groups, subjects undergone semi-standardized models of intensive multidisciplinary rehabilitation for 4–6 weeks. Primary outcome measures: Functional Independence Measure (FIM™), Modified Rankin scale (Rankin), and Glasgow Outcome Scale (GOS Subjects were evaluated at admission, discharge, and 6 months after discharge. Results: Improvement in motor FIM™, Rankin and GOS was observed in all groups. Cognitive FIM™ increase was less evident in TBI patients. After 6 months, 37.6% of patients were unemployed, 34% underwent outpatient rehabilitation, and 65.2% maintained gains. Conclusions: This is the first report on the effects from an inpatients rehabilitation model in Brazil. After a short intensive rehabilitation, there were motor and cognitive gains in all groups. Heterogeneity in functional gains suggests more individualized programs may be indicated. Controlled studies are required with larger samples to compare inpatient and outpatient programs.Implications for RehabilitationThe proposed brief model of rehabilitation for stroke, traumatic brain injury, spinal cord injury, and Guillain–Barre syndrome inpatients shows promising results in terms of functional improvement.Apparent improvements in cognitive and motor levels can be observed after 30 d of the intensive hospital-based program five times a week focusing on caregiver and patients training.After 6 months of discharge, more than one third of patients remained out of work, but appeared to have kept the benefits attained during hospitalization, and performed physical activities in the community as outpatients.

The Effectiveness of Botulinum Toxin Type A (BoNT-A) Treatment in Brazilian Patients with Chronic Post-Stroke Spasticity: Results from the Observational, Multicenter, Prospective BCause Study

“…These difficulties may be linked to the public healthcare system in Brazil, since over 90% of patients had public health insurance. Jorge and colleagues (2015) noted that there is a shortage of rehabilitation centers in Brazil, along with inadequate knowledge regarding the need for rehabilitation and poor organization between clinical services and rehabilitation centers [32]. A study assessing factors influencing the functional gain in patients post-stroke in Brazil found that the average time from stroke onset until admission to a rehabilitation program was 8.9 months, which was similar to the median waiting time for an appointment at a center in this study (9.0 months) [33].…”

Factors Associated with Return to Work Postinjury: Can the Modified Rankin Scale be Used to Predict Return to Work?

“…1 Postinjury RTW has often been measured as a primary outcome to assess the efficacy of comprehensive and multidisciplinary rehabilitation programs. 2 Patients that RTW have been demonstrated to have a higher degree of life satisfaction, overall quality of life, and economic independence. 3,4 Moreover, from a psychosocial standpoint, they experience decreased social isolation, reduced anxiety, as well as lower rates of substance abuse.…”

Intensive hospital rehabilitation model for patients with stroke in a developing country

“…In another study conducted by our research group with other neurologic patients, 11 general improvements in the Functional Independence Measure (FIM) and mRS was observed after the rehabilitation program discharge, evidencing that the intensive rehabilitation program is relevant for a better result. Performance measurements for patients with stroke must consider the treatment for post-acute term; however, there are still insufficient specific indicators of quality or standards for stroke rehabilitation.…”

“…10,11 However, individual goals has priority and demands that are noticed along the treatment are also considered objectives. The Ranking classification include the following therapy approaches:…”

“…20,21 Even though this research has shown that stroke patients with greater severity achieved functional progress after receiving multidisciplinary rehabilitation care, our study have some limitations regarding the sample size and the lack of a comparator. Nevertheless, as Jorge et al 11 claims, control groups, untreated or placebo, may raise concerns on ethics issues. Greater evidences could have been collected if other comparisons, such as upper and lower limbs capacities, gait and balance and other domains, however.…”