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Barbosa PM, Szrek H, Ferreira LN, Cruz VT, Firmino-Machado J. Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Ann Phys Rehabil Med 2024; 67:101824. [PMID: 38518399 DOI: 10.1016/j.rehab.2024.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
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Affiliation(s)
- Pedro Maciel Barbosa
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; Centro de Investigação em Reabilitação, Escola Superior de Saúde, Instituto Politécnico do Porto, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Helena Szrek
- Centre for Economics and Finance, University of Porto, R. Dr. Roberto Frias, 4200-464 Porto, Portugal
| | - Lara Noronha Ferreira
- ESGHT, Universidade do Algarve, Estr. da Penha 139, 8005-246 Faro, Portugal; Centre for Health Studies and Research of the University of Coimbra, Avenida Dias da Silva 165, 3004-512 Coimbra, Portugal; Research Centre for Tourism, Sustainability and Well-Being (CinTurs), Portugal.
| | - Vitor Tedim Cruz
- Hospital Pedro Hispano, Unidade Local de Saúde, EPE, Rua de Alfredo Cunha 365, 4450-021 Matosinhos, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
| | - João Firmino-Machado
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal; Centro Académico Clínico Egas Moniz, 810-193 Aveiro, Portugal; Centro Hospitalar Vila Nova de Gaia/Espinho, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Rodriquez J, Bullock D, Cotsonis G, Clark PC, Blanton S. Neighborhood socioeconomic disadvantage measures in rehabilitation clinical trials: Lessons learned in recruitment. Appl Nurs Res 2023; 73:151718. [PMID: 37722786 DOI: 10.1016/j.apnr.2023.151718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
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Affiliation(s)
- Josue Rodriquez
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - DeAndrea Bullock
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, United States of America.
| | - Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
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Yeh HJ, Chen TA, Cheng HC, Chou YJ, Huang N. Long-Term Rehabilitation Utilization Pattern Among Stroke Patients Under the National Health Insurance Program. Am J Phys Med Rehabil 2022; 101:129-134. [PMID: 33782272 DOI: 10.1097/phm.0000000000001747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand the frequency of patients receiving rehabilitation services at various periods after stroke and the possible medical barriers to receiving rehabilitation. DESIGN A retrospective cohort study was conducted using a nationally representative sample in Taiwan. A total of 14,600 stroke patients between 2005 and 2011 were included. Utilization of physical therapy or occupational therapy at different periods after stroke onset was the outcome variable. Individual and geographic characteristics were investigated to determine their effect on patients' probability of receiving rehabilitation. RESULTS More severe stroke or more comorbid diseases increased the odds of receiving physical therapy and occupational therapy; older age was associated with decreased odds. Notably, sex and stroke type influenced the odds of rehabilitation only in the early period. Copayment exemption lowered the odds of rehabilitation in the first 6 mos but increased the odds in later periods. Rural and suburban patients had significantly lower odds of receiving physical therapy and occupational therapy, as did patients living in areas with fewer rehabilitation therapists. CONCLUSIONS Besides personal factors, geographic factors such as urban-rural gaps and number of therapists were significantly associated with the utilization of post-stroke rehabilitation care. Furthermore, the influence of certain factors, such as sex, stroke type, and copayment exemption type, changed over time.
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Affiliation(s)
- Huan-Jui Yeh
- From the Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan (H-JY, T-AC); Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-JY, Y-JC); Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan (H-CC); Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); Department of Life Sciences and Institute of Genome Sciences, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan (H-CC); and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan (NH)
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Bayliss WS, Bushnell CD, Halladay JR, Duncan PW, Freburger JK, Kucharska-Newton AM, Trogdon JG. The Cost of Implementing and Sustaining the COMprehensive Post-Acute Stroke Services Model. Med Care 2021; 59:163-168. [PMID: 33273292 PMCID: PMC8594619 DOI: 10.1097/mlr.0000000000001462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged home, was tested against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. This study examined the hospital-level costs associated with implementing and sustaining COMPASS. METHODS Using an activity-based costing survey, we estimated hospital-level resource costs spent on COMPASS-related activities during approximately 1 year. We identified hospitals that were actively engaged in COMPASS during the year before the survey and collected resource cost estimates from 22 hospitals. We used median wage data from the Bureau of Labor Statistics and COMPASS enrollment data to estimate the hospital-level costs per COMPASS enrollee. RESULTS Between November 2017 and March 2019, 1582 patients received the COMPASS intervention across the 22 hospitals included in this analysis. Average annual hospital-level COMPASS costs were $2861 per patient (25th percentile: $735; 75th percentile: $3,475). Having 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient (P=0.016). About half (N=10) of hospitals reported postacute clinic visits as their highest-cost activity, while a third (N=7) reported case ascertainment (ie, identifying eligible patients) as their highest-cost activity. CONCLUSIONS We found that the costs of implementing COMPASS varied across hospitals. On average, hospitals with higher stroke volume and higher enrollment reported lower costs per patient. Based on average costs of COMPASS and readmissions for stroke patients, COMPASS could lower net costs if the model is able to prevent about 6 readmissions per year.
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Affiliation(s)
- William S Bayliss
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem
| | - Jacqueline R Halladay
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Pamela W Duncan
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, Pittsburgh, PA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
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Angerova Y, Marsalek P, Chmelova I, Gueye T, Uherek S, Briza J, Bartak M, Rogalewicz V. Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective. Int J Rehabil Res 2020; 43:376-382. [PMID: 32991353 PMCID: PMC7643793 DOI: 10.1097/mrr.0000000000000440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4-69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.
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Affiliation(s)
- Yvona Angerova
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha
| | - Pavel Marsalek
- Department of Rehabilitation, Krajská zdravotní, a.s., Masaryk Hospital in Ústí nad Labem, Ústí nad Labem
| | - Irina Chmelova
- Clinic of Rehabilitation and Physical Medicine
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava
| | - Tereza Gueye
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha
| | - Stepan Uherek
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno
| | - Jan Briza
- Surgical Clinic, General University Hospital, Praha
| | - Miroslav Bartak
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Praha
- Faculty of Health Studies, J. E. Purkyně University in Ústí nad Labem, Czech Republic
| | - Vladimir Rogalewicz
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Døhl Ø, Halsteinli V, Askim T, Gunnes M, Ihle-Hansen H, Indredavik B, Langhammer B, Phan A, Magnussen J. Factors contributing to post-stroke health care utilization and costs, secondary results from the life after stroke (LAST) study. BMC Health Serv Res 2020; 20:288. [PMID: 32252739 PMCID: PMC7137416 DOI: 10.1186/s12913-020-05158-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. METHODS The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥ 18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale < 5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n = 186) or standard care (n = 194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5 L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. RESULTS There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5 L. CONCLUSION Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5 L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. TRIAL REGISTRATION https://www.clinicaltrials.govNCT01467206. The trial was retrospectively registered after the first 6 participants were included.
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Affiliation(s)
- Øystein Døhl
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905 MTFS, N-7491 Trondheim, Norway
- Department of Health and Social Services, City of Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905 MTFS, N-7491 Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Gunnes
- Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hege Ihle-Hansen
- Department of Medicine, Vestre Viken, Bærum Hospital, Sandvika, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Birgitta Langhammer
- Faculty of Health Sciences, Oslo Metropolitian University, Oslo, Norway
- Sunnaas HF, Nesodden, Norway
| | - Ailan Phan
- Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Magnussen
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905 MTFS, N-7491 Trondheim, Norway
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Ontario Health (Quality). Continual Long-Term Physiotherapy After Stroke: A Health Technology Assessment. Ont Health Technol Assess Ser 2020; 20:1-70. [PMID: 32194882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stroke is a serious health issue in which an interruption in blood flow to any part of the brain damages brain cells. About 83% of people survive with substantial morbidity after their first stroke. We conducted a health technology assessment of continual long-term physiotherapy for people with a diagnosis of stroke, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding continual long-term physiotherapy for people with a diagnosis of stroke, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We also performed a systematic literature search of the economic evidence. We did not conduct a primary economic evaluation because there was insufficient clinical evidence. We also analyzed the budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario. To contextualize the potential value of continual long-term physiotherapy after stroke, we spoke with people who had been diagnosed with stroke, as well as their caregivers. RESULTS We did not find any published studies that met the specific clinical inclusion criteria. We did not identify any studies that compared the cost-effectiveness of continual long-term versus short-term physiotherapy after stroke. The budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario over the next 5 years ranges from $445,000 in year 1 at an uptake rate of 8% to $888,000 in year 5 at an uptake rate of 16%. The people who had been diagnosed with stroke with whom we spoke reported that they had benefitted from continual long-term physiotherapy. CONCLUSIONS We did not identify studies that addressed the specific research question. Based on the clinical evidence review, we are unable to determine the benefits of continual long-term compared with short-term physiotherapy after stroke. The cost-effectiveness of continual long-term physiotherapy after stroke in Ontario is unknown. We estimate that publicly funding continual long-term physiotherapy after stroke in Ontario would result in additional costs of between $445,000 and $888,000 annually over the next 5 years. Patients and caregivers who we spoke with felt that patients who have experienced a stroke should be able to continue with physiotherapy.
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Cao Y, Nie J, Sisto SA, Niewczyk P, Noyes K. Assessment of Differences in Inpatient Rehabilitation Services for Length of Stay and Health Outcomes Between US Medicare Advantage and Traditional Medicare Beneficiaries. JAMA Netw Open 2020; 3:e201204. [PMID: 32186746 PMCID: PMC7081121 DOI: 10.1001/jamanetworkopen.2020.1204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Enrollment in Medicare Advantage (MA) has been increasing and has reached one-third of total Medicare enrollment. Because of data limitations, direct comparison of inpatient rehabilitation services between MA and traditional Medicare (TM) beneficiaries has been very scarce. Subgroups of elderly individuals admitted to inpatient rehabilitation facilities (IRFs) may experience different care outcomes by insurance types. OBJECTIVE To measure the differences in length of stay and health outcomes of inpatient rehabilitation services between TM and MA beneficiaries in the US. DESIGN, SETTING, AND PARTICIPANTS This multiyear cross-sectional study used the Uniform Data System for Medical Rehabilitation to assess rehabilitation services received by elderly (aged >65 years) Medicare beneficiaries in IRFs between 2007 and 2016 for stroke, hip fracture, and joint replacement. Generalized linear models were used to assess whether an association existed between Medicare insurance type and IRF care outcomes. Models were adjusted for demographic characteristics, clinical conditions, and facility characteristics. Data were analyzed from September 2018 to August 2019. EXPOSURES Medicare insurance plan type, TM or MA. MAIN OUTCOMES AND MEASURES Inpatient length of stay in IRFs, functional improvements, and possibility of returning to the community after discharge. RESULTS The sample included a total of 1 028 470 patients (634 619 women [61.7%]; mean [SD] age, 78.23 [7.26] years): 473 017 patients admitted for stroke, 323 029 patients admitted for hip fracture, and 232 424 patients admitted for joint replacement. Individuals enrolled in MA plans were younger than TM beneficiaries (mean [SD] age, 76.96 [7.02] vs 77.95 [7.26] years for stroke, 79.92 [6.93] vs 80.85 [6.87] years for hip fracture, and 74.79 [6.58] vs 75.88 [6.80] years for joint replacement) and were more likely to be black (17 086 [25.5%] vs 54 648 [17.9%] beneficiaries) or Hispanic (14 496 [28.5%] vs 24 377 [8.3%] beneficiaries). The MA beneficiaries accounted for 21.8% (103 204 of 473 017) of admissions for stroke, 11.5% (37 160 of 323 029) of admissions for hip fracture, and 11.8% (27 314 of 232 424) of admissions for joint replacement. The MA beneficiaries had shorter mean lengths of stay than did TM beneficiaries for both stroke (0.11 day; 95% CI, -0.15 to -0.07 day; 1.15% shorter) and hip fracture (0.17 day; 95% CI, -0.21 to -0.13 day; 0.85% shorter). The MA beneficiaries also had higher possibilities of returning to the community than did TM beneficiaries, by 3.0% (95% CI, 2.6%-3.4%) for stroke and 5.0% (95% CI, 4.4%-5.6%) for hip fracture. The shorter length of stay and better ultimate outcomes were achieved without substantially compromising the intermediate functional improvements. Facility type (freestanding vs within an acute care hospital) and patient alternative payment sources other than Medicare (none vs other) partially explained the differences between insurance types. CONCLUSIONS AND RELEVANCE This study suggests that MA enrollees experience shorter length of stay and better outcomes for postacute care than do TM beneficiaries in IRFs. The magnitude of the differences depends on treatment deferability, patient sociodemographic subgroups, and facility characteristics.
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Affiliation(s)
- Ying Cao
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Jing Nie
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Sue Ann Sisto
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York
| | - Paulette Niewczyk
- Uniform Data System for Medical Rehabilitation, University at Buffalo, Buffalo, New York
| | - Katia Noyes
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
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Rose ML, Copland D, Nickels L, Togher L, Meinzer M, Rai T, Cadilhac DA, Kim J, Foster A, Carragher M, Hurley M, Godecke E. Constraint-induced or multi-modal personalized aphasia rehabilitation (COMPARE): A randomized controlled trial for stroke-related chronic aphasia. Int J Stroke 2019; 14:972-976. [PMID: 31496440 DOI: 10.1177/1747493019870401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE The comparative efficacy and cost-effectiveness of constraint-induced and multi-modality aphasia therapy in chronic stroke are unknown. AIMS AND HYPOTHESES In the COMPARE trial, we aim to determine whether Multi-Modal Aphasia Treatment (M-MAT) and Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) are superior to usual care (UC) for chronic post-stroke aphasia. Primary hypothesis: CIAT-Plus and M-MAT will reduce aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient (WAB-R-AQ)) compared with UC: CIAT-Plus superior for moderate aphasia; M-MAT superior for mild and severe aphasia. SAMPLE SIZE ESTIMATES A total of 216 participants (72 per arm) will provide 90% power to detect a 5-point difference on the WAB-R-AQ between CIAT-Plus or M-MAT and UC at α = 0.05. METHODS AND DESIGN Prospective, randomized, parallel group, open-label, assessor blinded trial. Participants: Stroke >6 months; aphasia severity categorized using WAB-R-AQ. Computer-generated blocked and stratified randomization by aphasia severity (mild, moderate, and severe), to 3 arms: CIAT-Plus, M-MAT (both 30 h therapy over two weeks); UC (self-reported usual community care). STUDY OUTCOMES WAB-R-AQ immediately post-intervention. Secondary outcomes: WAB-R-AQ at 12-week follow-up; naming scores, discourse measures, Communicative Effectiveness Index, Scenario Test, and Stroke and Aphasia Quality of Life Scale-39 g immediately and at 12 weeks post-intervention; incremental cost-effectiveness ratios compared with UC at 12 weeks. DISCUSSION This trial will determine whether CIAT-Plus and M-MAT are superior and more cost-effective than UC in chronic aphasia. Participant subgroups with the greatest response to CIAT-Plus and M-MAT will be described.
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Affiliation(s)
- Miranda L Rose
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- ARC Centre of Excellence in Cognition and its Disorders (CCD), Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Marcus Meinzer
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Tapan Rai
- Graduate Research School, University of Technology Sydney, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Joosup Kim
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Abby Foster
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- Speech Pathology Department, Monash Health, Clayton, Australia
| | - Marcella Carragher
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Melanie Hurley
- Department of Speech Pathology, Audiology and Orthoptics, School of Allied Health, La Trobe University, Melbourne, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia
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Holmes K, Corbett D, McGowan S. Implementing the SRRR Taskforce Recommendations to Transform Stroke Recovery Research. Neurorehabil Neural Repair 2019; 33:933-934. [PMID: 31674266 DOI: 10.1177/1545968319888638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Barker-Collo S, Krishnamurthi R, Theadom A, Jones K, Starkey N, Feigin V. Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies. N Z Med J 2019; 132:40-54. [PMID: 31563926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIMS Traumatic Brain Injury (TBI) and stroke are the main causes of acquired brain injury. The differences in demographic profiles of stroke and TBI suggest that high-quality epidemiological studies of the two be compared. This study examined incidence of stroke and TBI by age and ethnicity in New Zealand. METHODS Incidence rates are presented by age and ethnicity from two New Zealand population-based epidemiological studies (Brain Injury Outcomes New Zealand In the Community (BIONIC); and Auckland Regional Outcomes of Stroke Studies (ARCOS-IV)). RESULTS Males and females had similar stroke risk, while males had 2x relative risk of mild TBI and 3x the relative risk of moderate/severe TBI compared to females. More TBI cases (35.6%) were identified through non-medical sources compared to stroke (3%). Incidence of TBI was greater than 5 times that of stroke. New Zealand European/Pākehā had the highest TBI incidence when less than 5 years of age, while Māori had the highest incidence after five years of age. For stroke, Pacific people and Māori had higher incidences until 75-84 years, after which Europeans had higher incidence. CONCLUSIONS Differences in TBI and stroke incidence suggest targeting prevention very differently for the two groups. Incidence profiles suggest TBI is much more common; and a need to target males and those of Māori ethnicity for TBI prevention.
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Affiliation(s)
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | - Kelly Jones
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland
| | | | - Valery Feigin
- National Institute for Stroke and Applied Neurorehabilitation(NISAN), AUT University, Auckland, on behalf of the BIONIC and ARCOS-IV study groups
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Vo TQ, Le PH. Post-stroke rehabilitation cost with traditional therapy: Evidence from a public hospital. J PAK MED ASSOC 2019; 69(Suppl 2):S87-S95. [PMID: 31369539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE After surviving from an acute phase of stroke, it is essential for stroke survivors to continue therapies to improve their function and quality of life. The aim of this study was to assess the influence of rehabilitation treatment on the society in economic aspect with evidence from a traditional hospital. METHODS A prospective cohort study was carried out with patients who were being treated at Traditional Medicine Hospital in Ho Chi Minh City after experiencing a stroke. Patients' relevant medical information was extracted from the hospital's database and placed on a structured questionnaire. RESULTS Among 103 eligible patients aged 60.3 } 11.4 years, 93.2% had experienced a stroke for the first time. Eighty-four patients were diagnosed with ischaemic stroke, while the number of haemorrhagic stroke patients was approximately 4.5 times lower (n = 19). The mean total cost was $3,310.40 USD, which included $1,653.60 USD, $539.90 USD and $1,117.00 USD for direct medical, direct non-medical and indirect cost, respectively. Hospital bed costs accounted for a considerable percentage of direct medical costs (41.0%). CONCLUSIONS Stroke was determined to be a significant social burden, although patients in this study had already suffered from the acute phase. This study gives decision makers a comparative view about the economic view on the economic burden of the stroke rehabilitation treatment between using traditional national Western and Eastern therapy.
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Affiliation(s)
- Trung Quang Vo
- Department of Economic and Administrative Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Phuong Hong Le
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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Gao L, Sheppard L, Wu O, Churilov L, Mohebbi M, Collier J, Bernhardt J, Ellery F, Dewey H, Moodie M. Economic evaluation of a phase III international randomised controlled trial of very early mobilisation after stroke (AVERT). BMJ Open 2019; 9:e026230. [PMID: 31118178 PMCID: PMC6537993 DOI: 10.1136/bmjopen-2018-026230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES While very early mobilisation (VEM) intervention for stroke patients was shown not to be effective at 3 months, 12 month clinical and economical outcomes remain unknown. The aim was to assess cost-effectiveness of a VEM intervention within a phase III randomised controlled trial (RCT). DESIGN An economic evaluation alongside a RCT, and detailed resource use and cost analysis over 12 months post-acute stroke. SETTING Multi-country RCT involved 58 stroke centres. PARTICIPANTS 2104 patients with acute stroke who were admitted to a stroke unit. INTERVENTION A very early rehabilitation intervention within 24 hours of stroke onset METHODS: Cost-utility analyses were undertaken according to pre-specified protocol measuring VEM against usual care (UC) based on 12 month outcomes. The analysis was conducted using both health sector and societal perspectives. Unit costs were sourced from participating countries. Details on resource use (both health and non-health) were sourced from cost case report form. Dichotomised modified Rankin Scale (mRS) scores (0 to 2 vs 3 to 6) and quality adjusted-life years (QALYs) were used to compare the treatment effect of VEM and UC. The base case analysis was performed on an intention-to-treat basis and 95% CI for cost and QALYs were estimated by bootstrapping. Sensitivity analysis were conducted to examine the robustness of base case results. RESULTS VEM and UC groups were comparable in the quantity of resource use and cost of each component. There were no differences in the probability of achieving a favourable mRS outcome (0.030, 95% CI -0.022 to 0.082), QALYs (0.013, 95% CI -0.041 to 0.016) and cost (AUD1082, 95% CI -$2520 to $4685 from a health sector perspective or AUD102, 95% CI -$6907 to $7111, from a societal perspective including productivity cost). Sensitivity analysis achieved results with mostly overlapped CIs. CONCLUSIONS VEM and UC were associated with comparable costs, mRS outcome and QALY gains at 12 months. Compared with to UC, VEM is unlikely to be cost-effective. The long-term data collection during the trial also informed resource use and cost of care post-acute stroke across five participating countries. TRIAL REGISTRATION NUMBER ACTRN12606000185561; Results.
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Affiliation(s)
- Lan Gao
- Deakin University, Burwood, Victoria, Australia
| | | | | | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
| | | | - Janice Collier
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
| | - Fiona Ellery
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
| | - Helen Dewey
- Eastern Health, Box Hill, Victoria, Australia
| | - Marj Moodie
- Deakin University, Burwood, Victoria, Australia
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Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ 2019; 20:107-134. [PMID: 29909569 DOI: 10.1007/s10198-018-0984-0] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/03/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. RESULTS We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. CONCLUSION The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
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Affiliation(s)
- S Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - H Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Health Sciences/Public Health, Dresden Medical School "Carl Gustav Carus", Technical University Dresden, Dresden, Germany
| | - H H Borba
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - G Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - J Vujicic
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - T Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard Chan School of Public Health, Boston, MA, USA.
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
Improvement in hand function to promote functional recovery is one of the major goals of stroke rehabilitation. This paper introduces a newly developed exoskeleton for hand rehabilitation with a user-centered design concept, which integrates the requirements of practical use, mechanical structure, and control system. The paper also evaluated the function with two prototypes in a local hospital. Results of functional evaluation showed that significant improvements were found in ARAT (P = 0.014), WMFT (P = 0.020), and FMA_WH (P = 0.021). Increase in the mean values of FMA_SE was observed but without significant difference (P = 0.071). The improvement in ARAT score reflects the motor recovery in hand and finger functions. The increased FMA scores suggest there is a motor improvement in the whole upper limb, and especially in the hand after the training. The product met patients' requirements and has practical significance. It is portable, cost-effective, easy to use and supports multiple control modes to adapt to different rehabilitation phases.
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Lannin NA, Ada L, English C, Ratcliffe J, Crotty M. Effect of adding upper limb rehabilitation to botulinum toxin-A on upper limb activity after stroke: Protocol for the InTENSE trial. Int J Stroke 2018; 13:648-653. [PMID: 29553309 DOI: 10.1177/1747493018765228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Rationale Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. Aims To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. Sample size estimate A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0.05. Methods and design The InTENSE trial is a national, multicenter, Phase III randomized trial with concealed allocation, blinded assessment and intention-to-treat analysis. Stroke survivors who are scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than three months ago, who have completed formal rehabilitation and have no significant cognitive impairment will be randomly allocated to receive botulinum toxin-A plus evidence-based movement training or botulinum toxin-A alone. Study outcomes The primary outcomes are goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at three months (end of intervention) and at 12 months (beyond the intervention). Secondary outcomes are spasticity, range of motion, strength, pain, burden of care and health-related quality of life. Direct costs, personal costs and health system costs will be collected at 12 months. Discussion The results of the InTENSE trial are anticipated to directly influence intervention for moderate to severe spasticity after stroke. Trial Registration ANZCTR12615000616572.
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Affiliation(s)
- Natasha A Lannin
- 1 Department of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- 2 Alfred Health, Melbourne, Australia
- 3 John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
| | - Louise Ada
- 4 School of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Coralie English
- 5 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Julie Ratcliffe
- 6 Institute for Choice, UniSA Business School, University of South Australia, Adelaide, Australia
| | - Maria Crotty
- 7 Faculty of Medicine, Flinders University, Adelaide, Australia
- 8 Repatriation General Hospital, Adelaide, Australia
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Kim WS, Cho S, Park SH, Lee JY, Kwon S, Paik NJ. A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized, double-blind, sham-controlled pilot trial. Medicine (Baltimore) 2018; 97:e11173. [PMID: 29924029 PMCID: PMC6034563 DOI: 10.1097/md.0000000000011173] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke. METHODS A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke (<3 months) were allocated to sham (n = 11) and real VR group (n = 12). Both groups participated in a daily 30-minute occupational therapy for upper limb recovery for 10 consecutive weekdays. Subjects received an additional daily 30-minute Kinect-based or sham VR. Assessment was performed before the VR, immediately and 1 month after the last session of VR. Fugl-Meyer Assessment (FMA) (primary outcome) and other secondary functional outcomes were measured. Accelerometers were used to measure hemiparetic upper limb movements during the therapy. RESULTS FMA immediately after last VR session was not different between the sham (46.8 ± 16.0) and the real VR group (49.4 ± 14.2) (P = .937 in intention to treat analysis). Significant differences of total activity counts (TAC) were found in hemiparetic upper limb during the therapy between groups (F2,26 = 4.43; P = .22). Real VR group (107,926 ± 68,874) showed significantly more TACs compared with the sham VR group (46,686 ± 25,814) but there was no statistical significance between real VR and control (64,575 ± 27,533). CONCLUSION Low-cost Kinect-based upper limb rehabilitation system was not more efficacious compared with sham VR. However, the compliance in VR was good and VR system induced more arm motion than control and similar activity compared with the conventional therapy, which suggests its utility as an adjuvant additional therapy during inpatient stroke rehabilitation.
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Mamin FA, Islam MS, Rumana FS, Faruqui F. Profile of stroke patients treated at a rehabilitation centre in Bangladesh. BMC Res Notes 2017; 10:520. [PMID: 29078803 PMCID: PMC5658960 DOI: 10.1186/s13104-017-2844-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Stroke is the leading cause of death and disability in Bangladesh. Rehabilitation services have not yet been integrated into the Bangladesh health system. Only a few non-governmental organisations provide rehabilitation for stroke patients. The demographic profile of these patients has not yet been established. The aim of this study was to identify and evaluate the socio-demographic data, risk factors, place of primary management and cost of stroke for those who attended rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. A cross-sectional survey was carried out among 103 conveniently selected stroke patients who attended CRP between December 2015 and May 2016. RESULTS The mean age of the participants was 49 years. The majority (68%) originated from urban areas. About 85% of the patients had a history of hypertension prior to their stroke. Following the stroke, most patients received their initial treatment in a general clinic or hospital by registered physicians. Only 22% of the patients were advised to pursue follow-up rehabilitation services by their physicians. All patients interviewed in the survey received unpaid full-time care from their family members. The reported cost of rehabilitation was approximately US $328 per month per patient.
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Affiliation(s)
- Firoz Ahmed Mamin
- Department of Physiotherapy, Bangladesh Health Professions Institute (BHPI), CRP. Savar, Dhaka, 1343 Bangladesh
| | - Muhammad Shahidul Islam
- Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), CRP, Savar, Dhaka, 1343 Bangladesh
| | - Farjana Sharmin Rumana
- Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), CRP, Savar, Dhaka, 1343 Bangladesh
| | - Farhana Faruqui
- Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), CRP, Savar, Dhaka, 1343 Bangladesh
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Zhao Y, Guthridge S, Falhammar H, Flavell H, Cadilhac DA. Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia. BMJ Open 2017; 7:e015033. [PMID: 28982808 PMCID: PMC5640075 DOI: 10.1136/bmjopen-2016-015033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. DESIGN Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. SETTING Public hospitals in the NT from 1992 to 2013. PARTICIPANTS Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. RESULTS 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). CONCLUSIONS Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Howard Flavell
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Rodgers H, Shaw L, Bosomworth H, Aird L, Alvarado N, Andole S, Cohen DL, Dawson J, Eyre J, Finch T, Ford GA, Hislop J, Hogg S, Howel D, Hughes N, Krebs HI, Price C, Rochester L, Stamp E, Ternent L, Turner D, Vale L, Warburton E, van Wijck F, Wilkes S. Robot Assisted Training for the Upper Limb after Stroke (RATULS): study protocol for a randomised controlled trial. Trials 2017; 18:340. [PMID: 28728602 PMCID: PMC5520386 DOI: 10.1186/s13063-017-2083-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 07/04/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Loss of arm function is a common and distressing consequence of stroke. We describe the protocol for a pragmatic, multicentre randomised controlled trial to determine whether robot-assisted training improves upper limb function following stroke. METHODS/DESIGN Study design: a pragmatic, three-arm, multicentre randomised controlled trial, economic analysis and process evaluation. SETTING NHS stroke services. PARTICIPANTS adults with acute or chronic first-ever stroke (1 week to 5 years post stroke) causing moderate to severe upper limb functional limitation. Randomisation groups: 1. Robot-assisted training using the InMotion robotic gym system for 45 min, three times/week for 12 weeks 2. Enhanced upper limb therapy for 45 min, three times/week for 12 weeks 3. Usual NHS care in accordance with local clinical practice Randomisation: individual participant randomisation stratified by centre, time since stroke, and severity of upper limb impairment. PRIMARY OUTCOME upper limb function measured by the Action Research Arm Test (ARAT) at 3 months post randomisation. SECONDARY OUTCOMES upper limb impairment (Fugl-Meyer Test), activities of daily living (Barthel ADL Index), quality of life (Stroke Impact Scale, EQ-5D-5L), resource use, cost per quality-adjusted life year and adverse events, at 3 and 6 months. Blinding: outcomes are undertaken by blinded assessors. Economic analysis: micro-costing and economic evaluation of interventions compared to usual NHS care. A within-trial analysis, with an economic model will be used to extrapolate longer-term costs and outcomes. Process evaluation: semi-structured interviews with participants and professionals to seek their views and experiences of the rehabilitation that they have received or provided, and factors affecting the implementation of the trial. SAMPLE SIZE allowing for 10% attrition, 720 participants provide 80% power to detect a 15% difference in successful outcome between each of the treatment pairs. Successful outcome definition: baseline ARAT 0-7 must improve by 3 or more points; baseline ARAT 8-13 improve by 4 or more points; baseline ARAT 14-19 improve by 5 or more points; baseline ARAT 20-39 improve by 6 or more points. DISCUSSION The results from this trial will determine whether robot-assisted training improves upper limb function post stroke. TRIAL REGISTRATION ISRCTN, identifier: ISRCTN69371850 . Registered 4 October 2013.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH UK
| | - Lisa Shaw
- Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Helen Bosomworth
- Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH UK
| | - Natasha Alvarado
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust Queen’s Hospital, Rom Valley Way, Romford, Essex RM7 0AG UK
| | - David L. Cohen
- North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ UK
| | - Jesse Dawson
- University of Glasgow, Queen Elizabeth University Hospital, 1342 Govan Road, Govan, Glasgow, G51 4TF UK
| | - Janet Eyre
- Department of Child Health, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Tracy Finch
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Gary A. Ford
- Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU UK
- Oxford Academic Health Science Network, Magdalen Centre North Oxford Science Business Park, Oxford, OX4 4GA UK
| | - Jennifer Hislop
- Health Economics Group, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Steven Hogg
- Contact via: Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Niall Hughes
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, 1342 Govan Road, Govan, Glasgow, G51 4TF UK
| | - Hermano Igo Krebs
- Massachusetts Institute of Technology, 77 Massachusetts Avenue, 3-137, Cambridge, MA 02139 USA
| | - Christopher Price
- Stroke Research Group, Institute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL UK
| | - Elaine Stamp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Laura Ternent
- Health Economics Group, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Duncan Turner
- University of East London, School of Health, Sport and Biosciences, Stratford Campus, Water Lane, Stratford, London, E15 4LZ UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elizabeth Warburton
- Cambridge University Health Partners (Addenbrooke’s Hospital), R3 Neurosciences, Addenbrooke’s Hospital, Hills Road, Box 83, Cambridge, CB2 2QQ UK
| | - Frederike van Wijck
- Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Scott Wilkes
- Department of Pharmacy, Health and Wellbeing, Faculty of Applied Sciences, Science Complex, University of Sunderland, City Campus, Chester Road, Sunderland, SR1 3SD UK
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22
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan.
| | - Liang Zong
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital, Beijing, China; Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Liang Wang
- Department of Neurology, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Ying Xia
- Shanghai Key Laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan
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23
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Liu H, Lindley R, Alim M, Felix C, Gandhi DBC, Verma SJ, Tugnawat DK, Syrigapu A, Ramamurthy RK, Pandian JD, Walker M, Forster A, Anderson CS, Langhorne P, Murthy GVS, Shamanna BR, Hackett ML, Maulik PK, Harvey LA, Jan S. Protocol for process evaluation of a randomised controlled trial of family-led rehabilitation post stroke (ATTEND) in India. BMJ Open 2016; 6:e012027. [PMID: 27633636 PMCID: PMC5030603 DOI: 10.1136/bmjopen-2016-012027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We are undertaking a randomised controlled trial (fAmily led rehabiliTaTion aftEr stroke in INDia, ATTEND) evaluating training a family carer to enable maximal rehabilitation of patients with stroke-related disability; as a potentially affordable, culturally acceptable and effective intervention for use in India. A process evaluation is needed to understand how and why this complex intervention may be effective, and to capture important barriers and facilitators to its implementation. We describe the protocol for our process evaluation to encourage the development of in-process evaluation methodology and transparency in reporting. METHODS AND ANALYSIS The realist and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) frameworks informed the design. Mixed methods include semistructured interviews with health providers, patients and their carers, analysis of quantitative process data describing fidelity and dose of intervention, observations of trial set up and implementation, and the analysis of the cost data from the patients and their families perspective and programme budgets. These qualitative and quantitative data will be analysed iteratively prior to knowing the quantitative outcomes of the trial, and then triangulated with the results from the primary outcome evaluation. ETHICS AND DISSEMINATION The process evaluation has received ethical approval for all sites in India. In low-income and middle-income countries, the available human capital can form an approach to reducing the evidence practice gap, compared with the high cost alternatives available in established market economies. This process evaluation will provide insights into how such a programme can be implemented in practice and brought to scale. Through local stakeholder engagement and dissemination of findings globally we hope to build on patient-centred, cost-effective and sustainable models of stroke rehabilitation. TRIAL REGISTRATION NUMBER CTRI/2013/04/003557.
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Affiliation(s)
- Hueiming Liu
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Lindley
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammed Alim
- George Institute for Global Health, Hyderabad, Telangana, India
| | | | | | | | | | | | | | | | | | | | - Craig S Anderson
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | | - Maree L Hackett
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad, Telangana, India
- The George Institute for Global Health, Oxford University, Oxford, UK
| | - Lisa A Harvey
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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