Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

Abstract

Background and Purpose-Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay. Methods-An ICP for stroke rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (nϭ76) or conventional multidisciplinary care (nϭ76). Results-The age, sex, premorbid functional ability, and stroke characteristics of the 2 groups were comparable. There were no differences in mortality rates (10

Patient with stroke: hospital discharge planning, functionality and quality of life

“…Likewise, S 2 (8) and S 9 (15) presented similar results in this sense; quality of life did not improve with the application of an intervention when comparing two health care models; and a well-structured and monitored program did not show any advantage over a conventional multidisciplinary approach in terms of improved indicators of QoL.…”

“…When associating functionality with the perception of HRQoL, S 3 (9) confirms functional, personal/motor and social preservation (among other variables) is related to a better perception of HRQoL, being a significant predictor (S 8 (14) ) for lower hospitalization and mortality rates, also in the long term; on the other hand, it seems insensitive to the approaches experimentally used in one study (S 9 (15) ), whose objective was to evaluate the effectiveness of a structured program (ICP) in the reduction of length of stay, without affecting such functionality. Other studies/comments agree in these different realities; in S 11 (17) , the provision of training to caregivers of patients with stroke improves important aspects of their own lives but has no impact on the functionality of patients (when compared to usual procedures of caregivers without specific training).…”

“…The effects of participation in a program with these characteristics may persist in the long term, leading to care maintenance at home and reducing hospitalization and mortality rates. S 9 (15) Despite the numerous results, the study concluded that a well-structured and monitored program, especially in terms of objectives and duration (ICP -Integrated Care Pathway), did not show any advantage over a conventional multidisciplinary approach (regarding the functional recovery and indicators of quality of life), in patients with stroke followed up at stroke rehabilitation units. Such indicators of functional recovery and quality of life (QoL) were better and reached more quickly in the group that received a conventional multidisciplinary approach.…”

Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation

“…Importance of early rehabilitation in patients after stroke is apparent as it increases the possibility of recovery or compensation of dysfunctions (14). Occupational therapy is applied in rehabilitation of patients after stroke (15).…”

Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people: a pragmatic randomised controlled trial with microcost and qualitative analysis – the Community In-reach Rehabilitation And Care Transition (CIRACT) study

“…The point in a patient's hospital admission when discharge planning is implemented also varied across studies. 3,4 Two trials reported discharge planning commencing from the time that a patient was admitted to hospital 69,70 and another study reported that discharge planning was implemented 3 days prior to discharge. 71 The timing of delivery of an intervention such as discharge planning, which depends on organising other services, will have some bearing on how quickly these services can begin providing care.…”