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Abstract
Background The complications after stroke inhibit functional recovery and worsen the prognosis of patients. The implementation of a critical pathway (CP) can facilitate functional recovery after stroke by enabling comprehensive and systematic structured rehabilitation. Objective To evaluate the effects of the implementation of CP in stroke patients for 10 years. Methods The data were collected from 960 patients who were diagnosed with a stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase, and who were discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The modified Rankin Scale (mRS) and the Korean version of the Modified Barthel Index (K-MBI) were used to evaluate functional states. Results There were no significant differences in demographic and stroke characteristics before and after CP implementation. For those with preexisting medical conditions, there was no significant difference between before and after CP implementation. The majority of the complications were significantly decreased after the implementation of CP. Except for hemorrhagic stroke patients, the Brunnstrom stage in the ischemic and total stroke patients after CP implementation was significantly increased in the upper and lower extremities. The total hospitalization LOS and rehabilitation center hospitalization times were significantly reduced in ischemic and total stroke patients. There was no statistically significant difference in the functional gain of K-MBI and the efficiency of rehabilitation between before and after CP implementation. Conclusion The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practices in hospital care for stroke patients.
Highlights
Stroke has been a major cause of death and disability of people over 65 years old
The 960 patients diagnosed with ischemic or hemorrhagic stroke through examinations of brain computed tomography or magnetic resonance imaging, and based on findings obtained from patients’ history and physical examination, and transferred and discharged from the department of rehabilitation medicine upon completion of treatment of the acute phase followed by comprehensive rehabilitation treatment, were selected as subjects of the present study among patients who came to the emergency room of OO university hospital
Among all 960 subjects, the subjects belonging to the group before implementation of critical pathway (CP) were 100 subjects wherein 53 male subjects (53.0%) and 47 female subjects (47.0%) were included; the average age of the 100 subjects was 62:0 ± 13:1 years. 860 subjects belonging to the group after implementation of CP comprised 433 male subjects (50.3%) and 427 female subjects (49.7%), and the average age of the group was 63:9 ± 12:9 years
Summary
Stroke has been a major cause of death and disability of people over 65 years old. In Korea, the fast migration toward aging society accompanies increasing cases of stroke and causes rising economic burden [1, 2]. Researches on finding ways, enabling systematic and comprehensive treatment including specialized medical teams and facilities, to reduce the occurrence of complications and to promote functional recovery of patients, have been in progress [3]. Medical teams strive to provide the objective and accurate medical services for stroke patients, and the structured. The implementation of a critical pathway (CP) can facilitate functional recovery after stroke by enabling comprehensive and systematic structured rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. CP is still recommended as a means of promoting best practices in hospital care for stroke patients
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