Evaluation of Clinical Practice

The effect of two physiotherapy approaches on physical and cognitive functions and independent coping at home in stroke rehabilitation. A preliminary follow-up study

PURPOSE

Activating physiotherapy was used to support the principle of post stroke functional recovery as a learning process which requires both cognitive and physical actions. The purpose of the present preliminary study was to examine the influence of activating physiotherapy on stroke patients' cognitive and physical functions and independent living at home compared with traditional treatment over a 12-month follow-up.

METHODS

The 40 patients who received activating physiotherapy were compared with 40 patients receiving traditional therapy. Patients' physical functional capacity was measured one week and 12 months post stroke with the Barthel Index (BI), 10-m gait speed, the Postural Control and Balance for Stroke (PCBS) test, walking distances and patients' abilities to cope without outside help. Cognitive capacity was measured with specific neuropsychological tests: language, visuospatial functions, visual inattention and memory.

RESULTS

Physical functional capacity improved significantly (p = 0.001) in both groups at the 12-month follow-up, but no significant differences were found between groups. However, the patients in the activating therapy group coped better without outside help (p = 0.042) and covered longer distances outdoors (p = 0.012). At follow-up all the measured cognitive functions had improved significantly in the activating therapy group and the change in memory in the same group differed significantly from that in the traditional therapy group (p < 0.001), where no significant improvement was observed.

CONCLUSIONS

Activating therapy advanced stroke patients' cognitive and physical functional recovery and supported their return to independent life at home more than did traditional physiotherapy. In this respect activating therapy seems to have a beneficial influence on long-term stroke rehabilitation.

Patient perspective on quality of geriatric care and rehabilitation - development and psychometric testing of a questionnaire

The aim was to develop and test a questionnaire for use in telephone interviews concerning patient evaluation of geriatric care and rehabilitation. Instrument development was performed comprising qualitative interviews, construction of items, content validation, pilot study and data collection for evaluation of care and rehabilitation, clinical utility, reliability and construct validity. Qualitative interviews were performed with 12 elderly participants. The qualitative interviews formed the basis for the construction of 45 items. An expert panel performed a content validation of the questionnaire resulting in a revised version. A pilot study comprised 29 participants recently discharged from geriatric wards and the main data collection comprised 221 participants. Inclusion criteria were being able to perform a telephone interview and willingness to participate. Clinical utility was examined through questions to the interviewers, answered in writing. Cronbach's alpha coefficient was 0.79. According to a factor analysis and the evaluation of clinical utility, the underlying dimensions of the final revised questionnaire concern 'Respect and safety', 'Information and participation' and 'Rehabilitation interventions', scored in 18 items. In addition, one global item concerns satisfaction with care, resulting in 19 items in total. The revised questionnaire was named PaPeR, Patient Perspective on care and Rehabilitation. The questionnaire is considered valid, reliable and judged to have good clinical utility. The time consumption for the telephone interview is about 10-20 minutes. The questionnaire is useful in defining areas for potential quality improvement in geriatric wards.