Stroke rehabilitation: effectiveness, benefits, and cost. Some practical considerations.

The objective of this paper is to identify those variables that best predict a stroke patient's ability to live independently following his/her discharge from medical rehabilitation. The paper draws heavily on a formal research model grounded in independent living (IL) theory. Independent living is defined and operationalized as (1) the patient's ability to live in a nonrestrictive environment and (2) the patient's ability to live productively--not only in terms of gainful employment but also in terms of other contributions to community and family life. The main data source for the study is an extensive computer file of 84 stroke patients discharged from 8 medical rehabilitation centers. The multivariate statistical analysis indicates that 56 to 80 percent of the variance in a patient's ability to live independently can be explained or predicted mainly by the patient's marital status, age, Barthel score, communication impairments, and the ability to get into a motor vehicle. The paper concludes by discussing the implications of the findings for medical rehabilitation and public policy.

“…1 ' 2 This nihilism has been challenged by a variety of studies documenting the impact of rehabilitation therapy on stroke patients. '•…”

Section: Predicting the Stroke Patient's Ability To Live Independentlymentioning

confidence: 99%

Predicting the stroke patient's ability to live independently.

DeJong¹,

Branch²

1982

“…[1][2][3] Assuring that patients receive sufficient and cost-effective services has humanitarian, clinical, and policy motives but requires sophisticated modeling to distinguish rehabilitation benefits from natural recovery. Simple regression models use therapy intensity (dose) to predict functional status at discharge or functional gain (response).…”

mentioning

confidence: 99%

Relative Importance of Rehabilitation Therapy Characteristics on Functional Outcomes for Persons With Stroke

Bode

Heinemann

Semik

et al. 2004

Background and Purpose-The purpose of this study was to evaluate the relative importance of therapy focus, intensity, and length of stay on greater than expected functional gain, controlling for stroke severity. Methods-This observational study included 198 first-stroke patients who were recruited from 8 in-patient rehabilitation facilities and 5 subacute programs. Stroke severity (motor, sensory and cognitive impairment) at admission was measured using an instrument combining all 3 aspects; self-care, mobility, and cognitive status at admission and discharge were measured with the Functional Independence Measure. Time spent by physical, occupational, and speech-language therapists on function-and impairment-focused activities were used to compute therapy intensity by discipline and type of activity. Residual change scores, estimated by regressing discharge on admission functional status, were modeled using patient and therapy characteristics. Results-Controlling for the stroke severity, greater than expected gains in self-care were predicted by longer lengths of stay and more intensive function-focused occupational therapy, and greater than expected cognitive gains were predicted by longer stays alone. Predictors of residual change in mobility, however, differed by gender: greater than expected gains in mobility for men were predicted by longer lengths of stay and more intense function-focused physical therapy whereas, for women, they were predicted by stroke severity alone. Conclusions-Unlike previous studies using raw functional gains, therapies accounted for a significant proportion of the variance in residual functional change. The results support studies suggesting that both content and amount of therapy are important aspects.

“…Finally, the studies in the Holloway review used overall modeling (96%) as the principle research method. 4,5 In contrast to Holloway et al, 4,5 the objectives of this study were (1) to systematically obtain and review all published, trial-based, full economic evaluation studies in the field of stroke and (2) to gain insight into the methodological quality of both the epidemiological and the economic study design. This review focuses on trial-based studies rather than on studies based on modeling, for 2 reasons.…”

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confidence: 99%

Economic Evaluation in Stroke Research

Evers

Ament

Blaauw

2000

Background and Purpose-The purpose of this review is to provide insight into the quality of economic evaluation in the field of cerebrovascular diseases (CVD) on the basis of a systematic analysis. Methods-A literature search was performed using several sources. Trial-based full economic evaluation studies, were included in this review. The quality of the studies was independently assessed by 2 reviewers using a checklist. Results-Twenty-three articles were found to comply with our inclusion and exclusion criteria. Only a few studies mentioned the perspective of the study, and in these cases it was always the societal perspective. The majority of the studies were cost-minimization and cost-effectiveness analyses based on cohort studies. All studies included healthcare costs, and in some instances patient and family costs were considered. Costs were usually measured by tariffs. Clinical end points and mortality were used to measure effects. Cost and effect measurements were based on hospital records. Conclusions-Only a few full economic evaluations have been undertaken in the domain of CVD. In most of the studies, the technical execution and methodology were limited.