1
|
Razavilar N, Tran DT, Dukelow SP, Round J. Utilization of early supported discharge and outpatient rehabilitation services following inpatient stroke rehabilitation. Arch Public Health 2024; 82:80. [PMID: 38816872 PMCID: PMC11137928 DOI: 10.1186/s13690-024-01300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Studies examining factors associated with patient referral to early supported discharge (ESD)/outpatient rehabilitation (OPR) programs and utilization of ESD/OPR services after discharge from inpatient stroke rehabilitation (IPR) are scarce. Accordingly, we examined utilization of ESD/OPR services following discharge from IPR and patient factors associated with service utilization. METHODS Stroke patients discharged from IPR facilities in Alberta between April 2014 and March 2016 were included and followed for one year for ESD/OPR service utilization. Multivariable linear and negative binomial regressions were used to examine association of patients' factors with ESD/OPR use. RESULTS We included 752 patients (34.4% of 2,187 patients discharged from IPR) who had 40,772 ESD/OPR visits during one year of follow-up in the analysis. Mean and median ESD/OPR visits were 54.2 and 36 visits, respectively. Unadjusted ESD/OPR visits were lower in females and patients aged ≥ 60 years but were similar between urban and rural areas. After adjustment for patient factors, patients in urban areas and discharged home after IPR were associated with 83.5% and 61.9%, respectively, increase in ESD/OPR visits, while having a right-body stroke was associated with 23.5% increase. Older patients used ESD/OPR less than their younger counterparts (1.4% decrease per one year of older age). Available factors explained 12.3% of variation in ESD/OPR use. CONCLUSION ESD/OPR utilization after IPR in Alberta was low and varied across age and geographic locations. Factors associated with use of ESD/OPR were identified but they could not fully explain variation of ESD/OPR use.
Collapse
Affiliation(s)
| | - Dat T Tran
- Institute of Health Economics, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Cisek KK, Nguyen TNQ, Garcia-Rudolph A, Saurí J, Becerra Martinez H, Hines A, Kelleher JD. Predictors of social risk for post-ischemic stroke reintegration. Sci Rep 2024; 14:10110. [PMID: 38698076 PMCID: PMC11066106 DOI: 10.1038/s41598-024-60507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
After stroke rehabilitation, patients need to reintegrate back into their daily life, workplace and society. Reintegration involves complex processes depending on age, sex, stroke severity, cognitive, physical, as well as socioeconomic factors that impact long-term outcomes post-stroke. Moreover, post-stroke quality of life can be impacted by social risks of inadequate family, social, economic, housing and other supports needed by the patients. Social risks and barriers to successful reintegration are poorly understood yet critical for informing clinical or social interventions. Therefore, the aim of this work is to predict social risk at rehabilitation discharge using sociodemographic and clinical variables at rehabilitation admission and identify factors that contribute to this risk. A Gradient Boosting modelling methodology based on decision trees was applied to a Catalan 217-patient cohort of mostly young (mean age 52.7), male (66.4%), ischemic stroke survivors. The modelling task was to predict an individual's social risk upon discharge from rehabilitation based on 16 different demographic, diagnostic and social risk variables (family support, social support, economic status, cohabitation and home accessibility at admission). To correct for imbalance in patient sample numbers with high and low-risk levels (prediction target), five different datasets were prepared by varying the data subsampling methodology. For each of the five datasets a prediction model was trained and the analysis involves a comparison across these models. The training and validation results indicated that the models corrected for prediction target imbalance have similarly good performance (AUC 0.831-0.843) and validation (AUC 0.881 - 0.909). Furthermore, predictor variable importance ranked social support and economic status as the most important variables with the greatest contribution to social risk prediction, however, sex and age had a lesser, but still important, contribution. Due to the complex and multifactorial nature of social risk, factors in combination, including social support and economic status, drive social risk for individuals.
Collapse
Affiliation(s)
- Katryna K Cisek
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland.
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic.
| | - Thi Nguyet Que Nguyen
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland
| | - Alejandro Garcia-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
| | - Joan Saurí
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | | | - Andrew Hines
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - John D Kelleher
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
- ADAPT Research Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic
| |
Collapse
|
3
|
Pournajaf S, Pellicciari L, Proietti S, Agostini F, Gabbani D, Goffredo M, Damiani C, Franceschini M. Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study. Int J Rehabil Res 2023; 46:230-237. [PMID: 37334818 PMCID: PMC10396075 DOI: 10.1097/mrr.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R 2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R 2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment.
Collapse
Affiliation(s)
- Sanaz Pournajaf
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | | | | | - Francesco Agostini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome
| | - Debora Gabbani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Carlo Damiani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- San Raffaele University, Rome, Italy
| |
Collapse
|
4
|
Length of Stay and Home Discharge for Patients with Inpatient Stroke Rehabilitation. Neurol Sci 2023; 50:28-36. [PMID: 34666861 DOI: 10.1017/cjn.2021.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine temporal trends and geographic variations and predict inpatient rehabilitation (IPR) length of stay (LOS) and home discharge for stroke patients. METHODS Patients aged ≥18 years who were admitted to an IPR facility in Alberta, Canada, between 04/2014 and 03/2018 (years 2014-2017) were included. Predictors of LOS and home discharge were examined using 2014-2016 data and validated using 2017 data. Multivariable linear regression (MLR), multivariable negative binomial (MNB), and multivariable quantile regressions (MQR) were used to examine LOS, and logistic regression was used for home discharge. RESULTS We included 2686 rehabilitation admissions between 2014 and 2017. The mean LOS decreased (2014: 71 days; 2017: 62.1 days; p = 0.003) during the study period and was shortest in Edmonton (59.1 days) compared to Calgary (66 days) or other localities (70.8 days; p < 0.001). Three-quarters of patients were discharged home and this proportion remained unchanged between 2014 and 2017. Calgary patients were more likely to be discharged home than those in Edmonton (OR = 0.62; p = 0.019) or other localities (OR = 0.39; p = 0.011). The MLR and MNB models provided accurate prediction for the mean LOS (predicted = 59.9 and 60.8 days, respectively, vs. actual = 62.1 days; both p > 0.5), while the MQR model did so for the median LOS (predicted = 44.3 days vs. actual = 44 days; p = 0.09). The logistic regression resulted in 82.4% of correct prediction, a sensitivity of 91.6%, and a specificity of 50.7% for home discharge. CONCLUSIONS Rehabilitation LOS decreased while the proportion of home discharge remained unchanged during the study period. Both varied across health zones. Identifiable statistical models provided accurate prediction with a separate patient cohort.
Collapse
|
5
|
García-Rudolph A, Kelleher JD, Cegarra B, Saurí Ruiz J, Nedumpozhimana V, Opisso E, Tormos JM, Bernabeu M. The impact of Body Mass Index on functional rehabilitation outcomes of working-age inpatients with stroke. Eur J Phys Rehabil Med 2020; 57:216-226. [PMID: 33263247 DOI: 10.23736/s1973-9087.20.06411-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is the most relevant cause of acquired persistent disability in adulthood. The relationship between patient's weight during rehabilitation and stroke functional outcome is controversial, previous research reported positive, negative and no effects, with scarce studies specifically addressing working-age patients. AIM To evaluate the association between Body Mass Index (BMI) and the functional progress of adult (<65 years) patients with stroke admitted to a rehabilitation hospital. DESIGN Retrospective observational cohort study. SETTING Inpatient rehabilitation center. POPULATION 178 stroke patients (ischemic or hemorrhagic). METHODS Point-biserial and Spearman's correlations, multivariate linear regressions and analysis of covariance were used to describe differences in functional outcomes after adjusting for age, sex, severity, dysphagia, depression and BMI category. Functional Independence Measure (FIM), FIM gain, efficiency and effectiveness were assessed. RESULTS Participants were separated in 3 BMI categories: normal weight (47%), overweight (33%) and obese (20%). There were no significant differences between BMI categories in any functional outcome (total FIM [T-FIM], cognitive [C-FIM]), motor [M-FIM]) at discharge, admission, gain, efficiency or effectiveness. In regression models BMI (as continuous variable) was not significant predictor of T-FIM at discharge after adjusting for age, sex, severity, dysphagia, depression and ataxia (R2=0.4813), significant predictors were T-FIM at admission (β=0.528) and NIHSS (β=-0.208). M-FIM efficiency did not significantly differ by BMI subgroups, neither did C-FIM efficiency. Length of stay (LOS) and T-FIM effectiveness were associated for normal (r=0.33) and overweight (r=0.43), but not for obese. LOS and T-FIM efficiency were strongly negatively associated only for obese (r=-0.50). CONCLUSIONS FIM outcomes were not associated to BMI, nevertheless each BMI category when individually considered (normal weight, overweight or obese) was characterized by different associations involving FIM outcomes and clinical factors. CLINICAL REHABILITATION IMPACT In subacute post-stroke working-age patients undergoing rehabilitation, BMI was not associated to FIM outcomes (no obesity paradox was reported in this sample). Distinctive significant associations emerged within each BMI category, (supporting their characterization) such as length of stay and T-FIM effectiveness were associated for normal weight and overweight, but not for obese. Length of stay and T-FIM efficiency were strongly negatively associated only for obese.
Collapse
Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain - .,Universitat Autònoma de Barcelona, Bellaterra, Spain - .,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain -
| | - John D Kelleher
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU), Dublin, Ireland
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Joan Saurí Ruiz
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Vasudevan Nedumpozhimana
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU), Dublin, Ireland
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
6
|
García-Rudolph A, Cegarra B, Opisso E, Tormos JM, Bernabeu M, Saurí J. Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments. Medicine (Baltimore) 2020; 99:e22423. [PMID: 33120737 PMCID: PMC7581132 DOI: 10.1097/md.0000000000022423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission.A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated (P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models.No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) (P < .001) and hemiparesis (P = .0108) (adjusted R = 0.24), 2) cognitive FIM (P = .002) and severity (P = .001) (adjusted R = 0.22), and 3) home accessibility (P = .043) and hemiparesis (P = 0.032) (adjusted R = 0.19).Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset.Socioeconomic situation was found moderately correlated with total FIM (r = -0.32, P < .0001).When stratifying the patients' socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group (P < .001); also significant differences were found between mild and severe groups (P < .001).A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients.Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.
Collapse
Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
- Universitat de Barcelona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
| | - Joan Saurí
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès)
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona
| |
Collapse
|
7
|
García-Rudolph A, García-Molina A, Opisso E, Tormos JM, Bernabeu M. Cognition assessments to predict inpatient falls in a subacute stroke rehabilitation setting. Top Stroke Rehabil 2020; 28:52-60. [PMID: 32431244 DOI: 10.1080/10749357.2020.1765660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Stroke-related falls occur at especially high rates in rehabilitation settings. Inpatient-hospital falls have been identified as one of the most common medical complications after stroke, negatively influencing recovery, nevertheless, the role of cognition in relation to falls during inpatient rehabilitation is largely unexplored. Objective. We aim to predict inpatient falls in a subacute stroke rehabilitation setting using previously reported variables such as stroke severity, gender, age, ataxia, hemiparesis, and functionality in activities of daily living, further extending them with specific cognition variables assessing memory, verbal fluency, attention, and orientation. Methods: This observational study included 158 stroke patients admitted to a rehabilitation center between 2007 and 2019, with less than 30 days since stroke onset to admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Four logistic regressions were performed including NIHSS, age, sex, ataxia, and hemiparesis plus one of the following: (1) Functional Independence Measure cognitive (C-FIM) and motor (M-FIM) subtests. (2) individual C-FIM items, (3) Ray Auditory Verbal Memory Test (RAVLT) and (4) verbal fluency test (PMR), Digit Span from Wechsler Adult Intelligence Scale (WAIS III), and Orientation from Test Barcelona. Results: Neither NIHSS, age, sex, ataxia nor hemiparesis predicted falls. C-FIM was a significant predictor (AUC:0.891), but not M-FIM. The problem solving C-FIM item (AUC:0.836), the RAVLT learning subtest (AUC:0.879), and PMR verbal fluency (AUC:0.871) were significant predictors for each model, respectively. Conclusions: Cognition assessments, i.e., one FIM item, one RAVLT item, or a one-minute verbal fluency test are significant falls predictors.
Collapse
Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.,Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.,Fundació Institut d'Investigació En Ciències De La Salut Germans Trias I Pujol , Barcelona, Spain
| | - Alberto García-Molina
- Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.,Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.,Fundació Institut d'Investigació En Ciències De La Salut Germans Trias I Pujol , Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.,Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.,Fundació Institut d'Investigació En Ciències De La Salut Germans Trias I Pujol , Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.,Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.,Fundació Institut d'Investigació En Ciències De La Salut Germans Trias I Pujol , Barcelona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari De Neurorehabilitació Adscrit a La UAB , Barcelona, Spain.,Bellaterra (Cerdanyola Del Vallès), Universitat Autònoma De Barcelona , Spain.,Fundació Institut d'Investigació En Ciències De La Salut Germans Trias I Pujol , Barcelona, Spain
| |
Collapse
|
8
|
Tyagi S, Koh GCH, Luo N, Tan KB, Hoenig H, Matchar DB, Yoong J, Chan A, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Tan CS. Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study. BMJ Open 2020; 10:e036631. [PMID: 32332008 PMCID: PMC7204848 DOI: 10.1136/bmjopen-2019-036631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting. DESIGN Prospective cohort study. SETTING Community setting. PARTICIPANTS We recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke. OUTCOME MEASURES SCR participation over the first 3 months and subsequent 3 to 12 months post-stroke RESULTS: 251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor's disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver's positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068). CONCLUSION We established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.
Collapse
Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina, USA
| | - David Bruce Matchar
- Internal Medicine, Duke University, Durham, North Carolina, USA
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Graduate Medical School, Singapore
| | | | | | | | - Kin Ming Chan
- Geriatric Medicine, Mount Alvernia Hospital, Singapore
| | | | - Philip Yap
- Geriatric Centre, Khoo Teck Puat Hospital, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| |
Collapse
|