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Chen TP, Lin YJ, Wang YL, Wu LM, Ho CH. Impact of Interprofessional Collaborative Practice on Functional Improvements Among Post-Acute Stroke Survivors: A Retrospective Cross-Sectional Study. J Multidiscip Healthc 2024; 17:3945-3956. [PMID: 39161540 PMCID: PMC11331037 DOI: 10.2147/jmdh.s467777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024] Open
Abstract
Background Stroke survivors in post-acute care frequently experience physiological dysfunction and reduced quality of life. This study aims to assess the impact of the Post-Acute Care Interprofessional Collaborative Practice (PAC-IPCP) program across different care settings, and to identify sensitive tools for assessing physiological functions among post-acute stroke survivors. Methods This retrospective study involved 210 stroke survivors in Taiwan. Participants who self-selection for their preferred between hospital care setting and home care setting under PAC-IPCP. Multiple assessment tools were utilized, including the Barthel Index (BI), Functional Oral Intake Scale (FOIS), Mini Nutritional Assessment (MNA), EQ-5D-3L, and Instrumental Activities of Daily Living (IADL). The logistic regression was used to estimate the odds ratios of various functional assessment tools between hospital and home care settings. Additionally, the area under the ROC curves was used to determine which functional assessment tools had higher accuracy in measuring the association between care settings. Results Of the study population, 138 stroke survivors (65.71%) selection hospital care setting and 72 stroke survivors (34.29%) selection home care setting. The PAC-IPCP program was equally effective in both care settings for physical function status and quality of life improvements. Specifically, the BI emerged as the most sensitive tool for assessing care settings, with an adjusted OR of 1.04 (95% CI:1.02-1.07, p < 0.0001; AUC = 0.7557). IPCP-based hospital and home care models are equally effective in facilitating improved functional outcomes in post-acute stroke survivors. Conclusion The PAC-IPCP program is versatile and effective across care settings. The BI stands out as a robust assessment tool for physiological functions, endorsing its broader clinical application. Future studies should also consider swallowing and nutritional status for a more holistic approach to rehabilitation.
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Affiliation(s)
- Tsen-Pei Chen
- Department of Nursing, Chi Mei Medical Center, Tainan City, Taiwan
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ying-Jia Lin
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yu-Lin Wang
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan,Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
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Yin Z, Deng Y, Li Z, Gu H, Zhou Q, Wang Y, Wang C. Assessment of rehabilitation following acute ischaemic stroke in China: a registry-based retrospective observational study. BMJ Open 2024; 14:e082279. [PMID: 38553086 PMCID: PMC10982726 DOI: 10.1136/bmjopen-2023-082279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/01/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to describe the frequency, determinants and outcomes for assessment of patients who had an acute ischaemic stroke (AIS) for rehabilitation during hospitalisation in China. DESIGN A registry-based retrospective observational study. STUDY DESIGN AND SETTINGS Data regarding assessment or rehabilitation were extracted from the Chinese Stroke Center Alliance database from 1 August 2015 to 31 July 2019. Univariate and multivariate analyses were conducted to identify patient and hospital characteristics associated with rehabilitation assessment during acute hospitalisation as well as discharge outcomes. STUDY COHORT We included 837 897 patients who had a stroke in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital designation. PRIMARY AND SECONDARY OUTCOME MEASURES Rehabilitation assessment and discharge outcomes. RESULTS Among 837 897 patients who had a stroke admitted to 1473 hospitals, 615 991 (73.5%) underwent rehabilitation assessment. There were significant variations in the rates of rehabilitation assessment across hospitals (IQR 61.3% vs 92.9%). According to multivariate analysis, guideline recommended care delivery was associated with a higher rehabilitation assessment rate, whereas high/low body mass index, ambulation (OR 0.88; 95% CI 0.87 to 0.90), history of stroke (OR 0.94; 95% CI 0.93 to 0.95), coronary heart disease (OR 0.84; 95% CI 0.82 to 0.85) and atrial fibrillation (OR 0.91; 95% CI 0.89 to 0.94) were associated with a lower rate. Additionally, rehabilitation assessment during hospitalisation was significantly associated with lower in-hospital mortality (OR 0.38; 95% CI 0.35 to 0.41) and a higher probability of discharge to a rehabilitation centre (OR 2.66; 95% CI 2.5 to 2.82). CONCLUSIONS Nearly one-quarter of patients who had an AIS do not undergo documented rehabilitation assessment and compliance across hospitals varies. Thus, it is necessary to improve adherence to rehabilitation assessment to improve the quality of medical care for patients who had an AIS.
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Affiliation(s)
- Zhike Yin
- Beijing Tiantan Hospital, Beijing, China
| | | | - Zixiao Li
- Beijing Tiantan Hospital, Beijing, China
| | - Hongqiu Gu
- Beijing Tiantan Hospital, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Beijing, China
| | - Yongjun Wang
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Chunjuan Wang
- Vascular Neurology Department of Neurology, Capital Medical University, Beijing, China
- Capital Medical University, Beijing, China
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Dalli LL, Borschmann K, Cooke S, Kilkenny MF, Andrew NE, Scott D, Ebeling PR, Lannin NA, Grimley R, Sundararajan V, Katzenellenbogen JM, Cadilhac DA. Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life. Stroke 2023; 54:2593-2601. [PMID: 37581266 DOI: 10.1161/strokeaha.123.043094] [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: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Fractures are a serious consequence following stroke, but it is unclear how these events influence health-related quality of life (HRQoL). We aimed to compare annualized rates of fractures before and after stroke or transient ischemic attack (TIA), identify associated factors, and examine the relationship with HRQoL after stroke/TIA. METHODS Retrospective cohort study using data from the Australian Stroke Clinical Registry (2009-2013) linked with hospital administrative and mortality data. Rates of fractures were assessed in the 1-year period before and after stroke/TIA. Negative binomial regression, with censoring at death, was used to identify factors associated with fractures after stroke/TIA. Respondents provided HRQoL data once between 90 and 180 days after stroke/TIA using the EuroQoL 5-dimensional 3-level instrument. Adjusted logistic regression was used to assess differences in HRQoL at 90 to 180 days by previous fracture. RESULTS Among 13 594 adult survivors of stroke/TIA (49.7% aged ≥75 years, 45.5% female, 47.9% unable to walk on admission), 618 fractures occurred in the year before stroke/TIA (45 fractures per 1000 person-years) compared with 888 fractures in the year after stroke/TIA (74 fractures per 1000 person-years). This represented a relative increase of 63% (95% CI, 47%-80%). Factors associated with poststroke fractures included being female (incidence rate ratio [IRR], 1.34 [95% CI, 1.05-1.72]), increased age (per 10-year increase, IRR, 1.35 [95% CI, 1.21-1.50]), history of prior fracture(s; IRR, 2.56 [95% CI, 1.77-3.70]), and higher Charlson Comorbidity Scores (per 1-point increase, IRR, 1.18 [95% CI, 1.10-1.27]). Receipt of stroke unit care was associated with fewer poststroke fractures (IRR, 0.67 [95% CI, 0.49-0.93]). HRQoL at 90 to 180 days was worse among patients with prior fracture across the domains of mobility, self-care, usual activities, and pain/discomfort. CONCLUSIONS Fracture risk increases substantially after stroke/TIA, and a history of these events is associated with poorer HRQoL at 90 to 180 days after stroke/TIA.
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Affiliation(s)
- Lachlan L Dalli
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
| | - Karen Borschmann
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
- Allied Health Department, St Vincent's Hospital, Melbourne, VIC, Australia (K.B.)
| | - Shae Cooke
- Eastern Health, Box Hill, VIC, Australia (S.C.)
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia (N.E.A.)
- National Centre for Healthy Ageing, Frankston, VIC, Australia (N.E.A.)
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia (D.S.)
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia (N.A.L.)
- Alfred Health, Melbourne, VIC, Australia (N.A.L.)
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, QLD, Australia (R.G.)
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, VIC, Australia (V.S.)
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Australia (J.M.K.)
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.F.K., D.S., P.R.E., R.G., D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia (K.B., M.F.K., D.A.C.)
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Chen YT, Wu MR, Li ZX, Gu HQ, Zhou Q, Wang DD, Wang YJ, Xing-Quan Zhao. Assessment of rehabilitation following subarachnoid haemorrhage in China: findings from the Chinese Stroke Center Alliance. BMC Neurol 2023; 23:291. [PMID: 37542260 PMCID: PMC10403933 DOI: 10.1186/s12883-023-03349-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Rehabilitation improves functional recovery in subarachnoid hemorrhage (SAH) patients, and assessing patients for rehabilitation is the first step in this process. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation for patients with SAH. METHODS To identify patients hospitalized with SAH and to analyze rehabilitation assessment rates, we used data for 11,234 SAH patients admitted to 861 hospitals from the China Stroke Center Alliance from August 2015 to July 2019. We examined factors for rehabilitation assessment and analyzed the relationship between rehabilitation assessment and outcomes in these patients. RESULTS Among 11,234 patients with SAH, 6,513 (58.0%) were assessed for rehabilitation. Assessed patients had an increased length of stay (mean ± SD days: 17.3 ± 12.5 versus 11.6 ± 10.5, P = 49.4), a higher Glasgow Coma Scale (GCS) score on admission (mean ± SD GCS score: 12.3 ± 3.8 versus 11.8 ± 4.4, P = 12.2), and were more likely to be admitted to the stroke unit (19.6% versus 13.8%, P = 15.6). In multivariable analysis, factors associated with an increased likelihood of a rehabilitation assessment (p < 0.05) included a longer length of stay (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.04 to 1.05) and care such as dysphagia screening (OR, 1.88; 95% CI, 1.73 to 2.04), DVT prophylaxis (OR, 1.56; 95% CI, 1.41 to 1.72) and vessel evaluation (OR, 1.80; 95% CI, 1.63 to 1.98). For the multivariate analysis of outcomes, patients undergoing rehabilitation assessment had a longer length of stay (OR, 1.96; 95% CI, 1.81 to 2.12), a higher modified Rankin Scale (mRS) score at discharge (OR, 1.49; 95% CI, 1.36 to 1.64), and higher rates of discharge to a rehabilitation center (OR, 3.23; 95% CI, 1.81-5.75). CONCLUSION More than two-fifths of SAH patients were not assessed for rehabilitation. Rates vary considerably among hospital grades, and there is a need to improve adherence to recommended care for SAH patients.
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Affiliation(s)
- Yi-Tong Chen
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mei-Ru Wu
- Nursing Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zi-Xiao Li
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dan-Dan Wang
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xing-Quan Zhao
- Department of Neurology, Vascular Neurology Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Department of Neurology, Fengtai District, National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4Th Ring West Rd, Beijing, 100070, China.
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De Cola MC, Ielo A, Corallo F, Pollina Addario S, Scondotto S, Allotta A, Fantaci G, Bramanti P, Ciurleo R. Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke. Healthcare (Basel) 2023; 11:2065. [PMID: 37510506 PMCID: PMC10378746 DOI: 10.3390/healthcare11142065] [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: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Stroke is the leading global cause of permanent disability and the second leading cause of dementia within the first year of the event. Systematic quality improvement interventions such as Audit & Feedback (A&F) can monitor and improve the performance of post-stroke care in conjunction with the use of quality indicators (QIs). The scientific literature shows limited studies on quality improvement and QIs design for poststroke rehabilitation. In Italy, the National Outcomes Evaluation Programme (PNE) annually provides several QIs concerning the acute wards. On the contrary, indicators for quality assessment of post-acute stroke rehabilitation are not available nationwide. In recent years, the Italian Ministry of Health has funded a national network project, the aim of which is to provide and evaluate the effectiveness of A&F strategies in healthcare improvement. Part of this project is the development of a set of IQs for ischemic stroke rehabilitation used to conduct an A&F. In this study, we describe the design and development process of these QIs from administrative databases and report the results of the pilot test conducted on a small sample of Sicilian rehabilitation facilities, comparing them from 2019 to 2021. Feedback from the participating centers was mainly positive, and the quality indicators were found to be comprehensible and appreciated. However, the study highlighted the need for better adherence to indicators measuring processes of rehabilitation care. The set of quality indicators presented in this study, relevant to inpatient settings, could be considered a starting point on which to base quality improvement initiatives both nationally and internationally.
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Affiliation(s)
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
| | | | - Sebastiano Pollina Addario
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Salvatore Scondotto
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Alessandra Allotta
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Giovanna Fantaci
- Assessorato della Salute, Dipartimento Attività Sanitarie e Osservatorio Epidemiologico, 90145 Palermo, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
- Faculty of Psychology, Università Degli Studi eCampus, Via Isimbardi 10, 22060 Novedrate, Italy
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Baker C, Foster AM, D'Souza S, Godecke E, Shiggins C, Lamborn E, Lanyon L, Kneebone I, Rose ML. Management of communication disability in the first 90 days after stroke: a scoping review. Disabil Rehabil 2022; 44:8524-8538. [PMID: 34919449 DOI: 10.1080/09638288.2021.2012843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. PURPOSE To explore the scope of literature for the management of communication disability in the first 90 days after stroke. MATERIALS AND METHODS A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). RESULTS A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). CONCLUSION A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
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Affiliation(s)
- Caroline Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia.,School of Primary & Allied Health Care, Monash University, Melbourne, Australia
| | - Sarah D'Souza
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Edwina Lamborn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lucette Lanyon
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadlands, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Marnane K, Gustafsson L, Bennett S, Rosbergen I, Grimley R. "Everyone needs rehab, but…": exploring post-stroke rehabilitation referral and acceptance decisions. Disabil Rehabil 2021; 44:4717-4728. [PMID: 33974463 DOI: 10.1080/09638288.2021.1918770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke. MATERIALS AND METHODS Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed. RESULTS Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes. CONCLUSIONS Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients.IMPLICATIONS FOR REHABILITATIONReferral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs.Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making.Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation.
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Affiliation(s)
- Kerry Marnane
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Community and Oral Health Directorate, Metro North Hospital and Health Service, Herston,Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Ingrid Rosbergen
- Conjoint Research Fellow Physiotherapy, STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Hospital and Health Service, Australia
| | - Rohan Grimley
- School of Medicine, Griffith University, Sunshine Coast, Australia
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Wu J, Misa O, Shiner CT, Faux SG. Targeted rehabilitation may improve patient flow and outcomes: development and implementation of a novel Proactive Rehabilitation Screening (PReS) service. BMJ Open Qual 2021; 10:bmjoq-2020-001267. [PMID: 33685858 PMCID: PMC7942267 DOI: 10.1136/bmjoq-2020-001267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/09/2022] Open
Abstract
Rehabilitation programmes can be delivered to patients receiving acute care (‘in-reach rehabilitation’) and/or those who have completed acute care but experience ongoing functional impairments (‘subacute rehabilitation’). Access to these programmes depends on a rehabilitation assessment, but there are concerns that referrals for this assessment are often triggered too late in the acute care journey. We describe a Proactive Rehabilitation Screening (PReS) process designed to systematically screen patients during an acute hospital admission, and identify early those who are likely to require specialist rehabilitation assessment and intervention. The process is based on review of patient medical records on day 5 after acute hospital admission, or day 3 after transfer from intensive care to an acute hospital ward. Screening involves brief review of documented care needs, pre-existing and new functional disabilities, the need for allied health interventions and non-medical factors delaying discharge. From May 2017 to February 2019, the novel screening process was implemented as part of a service redesign of the rehabilitation consultation service. Four thousand consecutive screens were performed at the study site. Of those ‘ruled in’ by screening as needing a rehabilitation assessment, 86.0% went on to receive inpatient rehabilitation interventions. Of those ‘ruled out’ by screening, 92.1% did not go on to receive a rehabilitation intervention, while 7.9% did receive some form of rehabilitation intervention. Of all patients accepted into a rehabilitation programme (n=516), PReS was able to identify 53.6% (n=282) of them before the acute care teams made a referral (based on traditional criteria). In conclusion, we have designed and implemented a systematic, PReS service in one metropolitan Australian hospital. The process described was found to be time efficient and feasible to implement in an acute hospital setting. Further, it appeared to identify the majority of patients who went on to receive formal inpatient rehabilitation interventions.
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Affiliation(s)
- Jane Wu
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Olivia Misa
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Christine T Shiner
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
| | - Steven G Faux
- St Vincent's Health Australia Ltd, Darlinghurst, New South Wales, Australia
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9
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Luo XC, Zhou J, Zhang YG, Liu YY, Li JJ, Zheng Z, Tong F, Feng F. Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21040. [PMID: 32702844 PMCID: PMC7373622 DOI: 10.1097/md.0000000000021040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER CRD42020169549.
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Affiliation(s)
- Xiao-Chao Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Jin Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yong-Gang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University
| | - Yao-Yao Liu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jia-Jia Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Zhen Zheng
- Physical Education School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Tong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine
| | - Fen Feng
- Hospital of Chengdu University of Traditional Chinese Medicine
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10
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Grimley RS, Rosbergen IC, Gustafsson L, Horton E, Green T, Cadigan G, Kuys S, Andrew NE, Cadilhac DA. Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study. Clin Rehabil 2020; 34:812-823. [PMID: 32389061 DOI: 10.1177/0269215520916899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aims of this study were to describe patterns and dose of rehabilitation received following stroke and to investigate their relationship with outcomes. DESIGN This was a prospective observational cohort study. SETTING A total of seven public hospitals and all subsequent rehabilitation services in Queensland, Australia, participated in the study. SUBJECTS Participants were consecutive patients surviving acute stroke between July 2016 and January 2017. METHODS We tracked rehabilitation for six months following stroke and obtained 90- to 180-day outcomes from the Australian Stroke Clinical Registry. MEASURES Dose of rehabilitation - time in therapy by physiotherapy, occupational therapy and speech pathology; modified Rankin Scale (mRS)- premorbid, acute care discharge and 90- to 180-day follow-up. RESULTS We recruited 504 patients, of whom 337 (median age = 73 years, 41% female) received 643 episodes of rehabilitation in 83 different services. Initial rehabilitation was predominantly inpatient (260/337, 77%) versus community-based (77/337, 21%). Therapy time was greater within inpatient services (median = 29 hours) compared to community-based (6 hours) or transition care (16 hours). Median (Quartile 1, Quartile 3) six-month cumulative therapy time was 73 hours (40, 130) when rehabilitation commenced in stroke units and continued in inpatient rehabilitation units; 43 hours (23, 78) when commenced in inpatient rehabilitation units; and 5 hours (2, 9) with only community rehabilitation. In 317 of 504 (63%) with follow-up data, improvement in mRS was most likely with inpatient rehabilitation (OR = 3.6, 95% CI = 1.7-7.7), lower with community rehabilitation (OR = 1.6, 95% CI = 0.7-3.8) compared to no rehabilitation, after adjustment for baseline factors. CONCLUSION Amount of therapy varied widely between rehabilitation pathways. Amount of therapy and chance of improvement in function were highest with inpatient rehabilitation.
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Affiliation(s)
- Rohan S Grimley
- Sunshine Coast Clinical School, Griffith University, Birtinya, QLD, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Queensland State-wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Ingrid Cm Rosbergen
- Queensland State-wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia.,Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
| | - Eleanor Horton
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Theresa Green
- Faculty of Health School of Nursing, The University of Queensland, Brisbane, QLD, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Greg Cadigan
- Queensland State-wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Suzanne Kuys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Nadine E Andrew
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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11
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Labberton AS, Barra M, Rønning OM, Thommessen B, Churilov L, Cadilhac DA, Lynch EA. Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway. BMC Health Serv Res 2019; 19:871. [PMID: 31752874 PMCID: PMC6873491 DOI: 10.1186/s12913-019-4713-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare. Methods We compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013–2014 (n = 553), and to one large university hospital in Norway in 2012–2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome. Results Participants were similar in both cohorts: mean age 73 years, 40–44% female, 12–13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process. Conclusions Similar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.
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Affiliation(s)
- Angela S Labberton
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mathias Barra
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Centre for Connected Care, Oslo University Hospital, Oslo, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Leonid Churilov
- Department of Medicine (Austin Health), Melbourne Medical School, The University of Melbourne, Heidelberg, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Dominique A Cadilhac
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Elizabeth A Lynch
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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