COMPARING INPATIENT REHABILITATION AND HOME-BASED REHABILITATION PRACTICES FOLLOWING ACUTE STROKE: A PROSPECTIVE CONTROLLED STUDY

Yıl 2023, , 69 - 76, 03.01.2023

Şükran Güzel , Azize Serçe , Ebru Umay , İbrahim Gündoğdu

https://doi.org/10.18229/kocatepetip.1015687

Öz

OBJECTIVE: The aim of this study is to evaluate whether home-based rehabilitation (HBR) is as effective as inpatient rehabilitation in patients with acute stroke as well as to identify patients at increased risk of mortality/morbidity during rehabilitation.
MATERIAL AND METHODS: The present study included 64 patients with acute stroke who were referred from the neurology service and intensive care units to an inpatient rehabilitation unit (n=28) or HBR programs (n=36). Brunnstrom motor stages, Functional Independence Measure and Stroke Impact Scale scores of all patients were recorded before treatment and 12 weeks after therapy. Evaluation parameters were compared between 2 groups. The presence of any morbidity/mortality that developed during rehabilitation period were recorded. Afterward, all the patients were divided into 3 groups as inpatient, HBR and patients with mortality/morbidity and evaluation parameters before therapy were compared among the groups.
RESULTS: At third month, while there was no significant change in all quality of life subscales following HBR, the improvement in all quality of life subscales following inpatient rehabilitation, except for the memory and emotion subscales were significant. At the end of 12th week; 5 (13.90%) of the 36 patients were died, and another 5 (13.90%) had developed a new cerebrovascular disease in HBR group. The memory, communication and emotion subscales scores of 10 patients with mortality/morbidity were significantly lower than the patients without mortality/morbidity in other 2 groups.
CONCLUSIONS: To better manage difficult clinical encounters, the physician needs to well identify acute stroke patients who will be referred to inpatient rehabilitation or home exercise group. When choosing a rehabilitation program, physicians may also consider the mortality/morbidity related to memory, communication and emotional scores.

Anahtar Kelimeler

Evde bakım, Rehabilitasyon, İnme, Yaşam kalitesi, Home care, Rehabilitation, Stroke, Quality of life

AKUT İNME SONRASI YATAN HASTA REHABİLİTASYONU VE EV TABANLI REHABİLİTASYON UYGULAMALARININ KARŞILAŞTIRILMASI: PROSPEKTiF KONTROLLÜ BİR ÇALIŞMA

Öz

AMAÇ: Bu çalışmanın amacı, akut inmeli hastalarda ev temelli rehabilitasyonun yatan hasta rehabilitasyonu kadar etkili olup olmadığını değerlendirmek ve rehabilitasyon sırasında yüksek mortalite/morbidite riski taşıyan hastaları belirlemektir.
GEREÇ VE YÖNTEM: Bu çalışmaya, nöroloji servisi ve yoğun bakım ünitelerinden yatan hasta rehabilitasyonu (n=28) veya ev egzersiz programlarına (n=36) yönlendirilen akut inmeli 64 hasta dahil edildi. Tedavi öncesi ve tedaviden 12 hafta sonra tüm hastaların Brunnstrom motor evreleri, Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ve İnme Etki Ölçeği (İEÖ) skorları kaydedildi. Değerlendirme parametreleri 2 grup arasında karşılaştırıldı. Rehabilitasyon süresince gelişen morbidite/mortalite varlığı kaydedildi. Daha sonra tüm hastalar yatan hasta, ev egzersiz ve mortalite/morbidite grubu olarak üç gruba ayrıldı ve tedavi öncesi değerlendirme parametreleri gruplar arasında karşılaştırıldı.
BULGULAR: Üçüncü ayda, ev egzersiz grubunda yaşam kalitesi ölçeklerinin tüm alt gruplarında anlamlı bir değişiklik olmazken, yatarak rehabilitasyon grubunda yaşam kalitesi ölçeklerinin bellek ve duygu alt ölçekleri dışında anlamlı iyileşme saptandı. 12. haftanın sonunda; ev egzersiz grubunda 36 hastanın 5'i (%13,90) öldü ve 5'inde (%13,90) yeni bir serebrovasküler hastalık gelişti. Mortalite/morbiditesi olan 10 hastanın bellek, iletişim ve duygu alt ölçek puanları, mortalite/morbiditesi olmayan diğer iki hasta grubundan anlamlı olarak daha düşüktü.
SONUÇ: Zor klinik durumları daha iyi yönetmek için hekimin yatan hasta rehabilitasyonu veya ev egzersiz grubuna yönlendirilecek akut inme hastalarını iyi belirlemesi gerekir. Hekimler hastaları bir rehabilitasyon programına yönlendirirken morbidite/mortalite ile ilgili olabilecek hafıza, iletişim ve emosyonel durum skorlarını göz önünde bulundurabilirler.

Anahtar Kelimeler

Evde bakım, Rehabilitasyon, İnme, Yaşam kalitesi, Home care, Rehabilitation, Stroke, Quality of life

Kaynakça

• 1. World Health Organization. https://www.who.int/news-room/fact- sheets/detail/the-top-10-causes-of-death. Erişim Tarihi:2016.
• 2. Yang Q, Mo C, Zheng H. Influence of rehabilitation of nursing home guide to patients with sequelae of stroke in community. China Med Pharm. 2016;6(12):128-30.
• 3. Pollock A, Baer G, Campbell P, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev. 2014;2014(4):CD001920.
• 4. Teasell R, Foley N, Salter K. Evidence based review of stroke rehabilitation. www.ebrsr.com. (Erişim tarihi: 2013).
• 5. Chaiyawat P, Kulkantrakorn K, Sritipsukho P. Effectiveness of home rehabilitation for ischemic stroke. Neurol Int. 2009;1(1):10.
• 6. Chi NF, Huang YC, Chiu HY, Chang HJ, Huang HC. Systematic Review and Meta-analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-dwelling Patients with a Stroke. Arch Med Res. 2019;101(2): 359-73.
• 7. Rasmussen RS, Østergaard A, Kjær P, et al. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial. Clin Rehabil. 2016;30(3):225-36.
• 8. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet.1991;337(8756):1521-6.
• 9. Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH. Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil. 2003;82(12):925- 35.
• 10. Duncan PW, Bode RK, Lai SM, Perera S, Glycine. Antagonist in Neuroprotection Americans Investigators. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil. 2013;84(7): 950-63.
• 11. Hantal AÖ, Doğu B, Büyükavcı R, Kuran B. İnme etki ölçeği 3,0: Türk toplumundaki inmeli hastalarda güvenilirlik ve geçerlilik çalışması. Türk Fiz Tıp Rehab Derg. 2014;60:106-16.
• 12. Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2001;15(3):311-19.
• 13. Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(6): 98-169.
• 14. Evers SMAA, Struijs JN, Ament AJHA, van Genugten MLL, Jager JC, van den Bos GAM. Comments, opinions and reviews: International comparison of stroke cost studies. Stroke. 2004;35:1209-15.
• 15. De Wit L, Putman K, Dejaeger E, et al. Use of time by stroke patients: a3comparison of four European rehabilitation centers. Stroke. 2005;36(9):1977-83.
• 16. Björkdahl A, Nilsson AL, Grimby G, Sunnerhagen KS. Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial. Clin Rehabil. 2006;20(12):1038-49.
• 17. Anderson C, Rubenach S, Mhurchu CN, Clark M, Spencer C, Winsor A. Home or hospital for stroke rehabilitation? results of a randomized controlled trial : I: health outcomes at 6 months. Stroke. 2000;31:1024-31.
• 18. Coleman ER, Moudgal R, Lang K, et al. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep. 2017;19(12):59.
• 19. Kim J, Thayabaranathan T, Donnan GA, et al. Global Stroke Statistics 2019. Int J Stroke. 2020;15(8):819-38.
• 20. Das S, Chandra Ghosh K, Malhotra M, Yadav U, Sankar Kundu S, Kumar Gangopadhyay P. Short term mortality predictors in acute stroke. Ann Neurosci. 2012;19(2):61-7.
• 21. Fearon P, Langhorne P. Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst Rev. 2012;12(9):443.
• 22. Royal College of Physicians, Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party. Sentinel Stroke National Audit Programme (SSNAP) clinical audit January-March 2016 public report. 5th edition, London: RCP; 2016.
• 23. Ramos-Lima MJM, Brasileiro IC, Lima TL, Braga-Neto P. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics(Sao Paulo). 2018;73:e418.
• 24. Chou CY. Determinants of the health-related quality of life for stroke survivors. J Stroke Cerebrovasc Dis. 2015;24(3):655-62.
• 25. Törnbom K, Perssom HC, Lundälv J, Sunnerhagen KS. Self-Assessed Physical, Cognitive, and Emotional Impact of Stroke at 1 Month: The Importance of Stroke Severity and Participation. J Stroke Cerebrovasc Dis. 2017;26(1):57-63.