Abstract
BackgroundAlmost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme.MethodsIn this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme.ResultsA part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients’ home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme.ConclusionThis study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.
Highlights
Introduction meeting of stroke care coordinatorAt least one home visit by 1) physical therapist and/or 2) occupational therapist to check for home adjustmentsAt least two therapy sessions in the patient’s homeModule 2: home based self-management training for patient and informal caregiver (4 months)Practicing self-management skillsInvolving informal caregiver in self-management trainingAt least two home visits to the patient by the stroke care coordinatorAt least 50% of the treatment sessions by 1) physical therapist and/or 2) occupational therapist at homeNumber of patients and informal caregivers participating in the intervention groupModule 3: stroke education for patient and informal caregiverNumber of education sessions performedNumber of patients and informal caregivers attending the education sessions
There is no evidence based geriatric rehabilitation programme available for older stroke patients combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit [18,19,20,21,22,23,24,25,26,27,28,29,30,31]
[33] The current paper presents the results of this process evaluation of which the aims were: 1) to evaluate to what extent the integrated multidisciplinary rehabilitation programme was performed according to protocol; 2) to evaluate the participation of the patients in the programme; and 3) to assess the opinion of patients, informal caregivers and care professionals on the programme [33]
Summary
Introduction meeting of stroke care coordinatorAt least one home visit by 1) physical therapist and/or 2) occupational therapist to check for home adjustmentsAt least two therapy sessions in the patient’s homeModule 2: home based self-management training for patient and informal caregiver (4 months)Practicing self-management skillsInvolving informal caregiver in self-management trainingAt least two home visits to the patient by the stroke care coordinatorAt least 50% of the treatment sessions by 1) physical therapist and/or 2) occupational therapist at homeNumber of patients and informal caregivers participating in the intervention group (module 1 & 2)Module 3: stroke education for patient and informal caregiverNumber of education sessions performedNumber of patients and informal caregivers attending the education sessions (module 3). We developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge such as paralysis, cognitive deficits, fatigue, behaviour problems and depression [6,7,8,9,10,11,12] These problems might result in a decrease of the patient’s functional level, increased social isolation and can eventually result in admission to a longterm care facility. These problems may have a negative impact on the care burden and quality of life of their informal caregivers [13, 14] This emphasizes the importance of continuity of care after home discharge of older stroke patients by providing adequate aftercare to prevent these problems
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