Profiles of functional outcomes in stroke rehabilitation for Chinese population: A cluster analysis

Louie, Stephanie Wai-Shan; Wong, Simon Kam-Man; Wong, Cynthia Mei-Yuk

doi:10.3233/nre-2009-0508

Cited by 10 publications

(7 citation statements)

References 31 publications

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“…The study findings were similar to those of previous studies. 10 , 22 , 23 , 36 – 38 The results of these studies confirmed that older adults had lower FIM scores. Additionally, the findings of these studies confirmed that a higher FIM score on admission is associated with higher scores on discharge.…”

Section: Discussionsupporting

confidence: 69%

Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia

Bindawas¹,

Vennu²,

Mawajdeh³

et al. 2017

CIA

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BackgroundAmong various risk factors, age has been identified as a nonmodifiable risk factor for stroke that influences functional outcomes after inpatient stroke rehabilitation in the developed world as well as in Saudi Arabia (SA). The demand for inpatient stroke rehabilitation services increases with population aging and stroke incidence; however, these services are limited in SA.ObjectiveTo examine functional outcomes by age after inpatient stroke rehabilitation in SA.Patients and methodsData from 418 patients with stroke who underwent inpatient stroke rehabilitation at the King Fahad Medical City-Rehabilitation Hospital, Riyadh, SA, between November 2008 and December 2014 were collected from electronic medical records. According to the patients’ age, we classified participants into two groups: adults, aged <65 years (n=255), and older adults, aged ≥65 years (n=163). All patients’ functional statuses at admission and discharge from inpatient stroke rehabilitation were assessed using the functional independence measure (FIM) scale.ResultsThe mean age was 59.9 years (SD =9.4). Older adults had significantly smaller changes in functional outcome from admission to discharge on both the total FIM (23 [SD =15.9]) and the motor FIM (21 [SD =15.4]), and they were significantly less independent (36%) compared to adults. In the adjusted models, older adults had significantly lower scores than adults, by 11 points (p<0.0001) for the total FIM score and by 10 points (p<0.0001) for the motor FIM subscale score. There was no significant change with age in the cognitive FIM subscale score.ConclusionAfter inpatient stroke rehabilitation, older adults had limited functional outcomes or were less independent than adults. However, the clinical relevance of this finding is questionable, so there is currently no justification to deny patients access to intensive stroke rehabilitation solely because of advanced age. Future large-scale research is needed to confirm rehabilitation outcomes by including confounders such as social support, socioeconomics, comorbidities, and the patient’s opinion after rehabilitation.

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Section: Discussionsupporting

confidence: 69%

Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia

Bindawas¹,

Vennu²,

Mawajdeh³

et al. 2017

CIA

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“…The present study showed that the groups of patients who had the greatest benefit from stroke rehabilitation program were those with admission categories of MFAC 3 to 5 in terms of MRMI efficiency and those with admission categories of MFAC 4 to 5 in terms of MBI efficiency. The present study echoes with Louie’s study 7 that patients with stroke with moderate disability on admission presented the best rate of improvement in functional outcomes on discharge. Under resource constraints, stroke rehabilitation teams have to stratify patients with stroke as soon as possible so as to allocate suitable resources, such as therapy sessions or LOS in hospital, to patients with stroke.…”

Section: Discussionsupporting

confidence: 87%

“…Early stratification of patients with stroke is useful for clinicians to recognize patients’ possible functional outcomes, level of disability and requirement for social support so as to facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification in clinical setting is usually based on admission functional scores such as Functional Independence Measure (FIM TM ), 5 Barthel Index (BI), 6 Modified BI (MBI), 7 and classification system such as Inpatient Rehabilitation Facility-Case-Mix Group (IRF-CMG). 8 However, these assessment tools are quite time-consuming and require a special training to complete the full score.…”

Section: Introductionmentioning

confidence: 99%

Stratification of stroke rehabilitation: Five-year profiles of functional outcomes

Chung

2018

Hong Kong Physiother. J.

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Background: Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score. Objective: The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation. Methods: This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed. Results: Subjects with admission categories of MFAC 2 and 3 had a highly significant ([Formula: see text]) MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant ([Formula: see text]) MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant ([Formula: see text]) MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant ([Formula: see text]) MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant ([Formula: see text]) LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC [Formula: see text] 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC [Formula: see text] 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively), discharge MRMI ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively) and discharge MBI ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively). Conclusion: This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.

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“…3,4 It was shown that patients with stroke who had as much practice as possible within 6 months after stroke onset could achieve the best functional outcome. [5][6][7] In Hong Kong, under the service model of Hospital Authority, patients would be referred to ambulatory services, such as geriatric day hospital, or domestic physiotherapy services to continue their stroke rehabilitation after discharge from hospital. However, some patients could not attend ambulatory services due to various di±culties, such as transportation and absence of carers.…”

Section: Introductionmentioning

confidence: 99%

Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial

Chung

Chiang

Lau

et al. 2020

Hong Kong Physiother. J.

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Objective: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. Methods: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. Results: A total of 56 participants were allocated to the experimental group [Formula: see text] and control group [Formula: see text]. There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. Conclusion: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

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Profiles of functional outcomes in stroke rehabilitation for Chinese population: A cluster analysis

Cited by 10 publications

References 31 publications

Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia

Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia

Stratification of stroke rehabilitation: Five-year profiles of functional outcomes

Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial

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