Home Rehabilitation System in Chronic Stroke: An Observational Study in Central Italy.

Abstract

By 6 months following a stroke, approximately 65% of stroke survivors cannot incorporate into daily activities, resulting completely dependent. The aim of this study is to assess the overall outcome in psychological and physical well-being, increase in residual abilities, reintegration and social inclusion for people with chronic disabilities resulting from stroke, after home rehabilitation. We assessed the functional outcome of a group of 600 patients with disability related to several pathological conditions and undergoing home rehabilitation therapy (twice a week for 40 sessions per year) as granted by the Public Health. We evaluated the outcome with Barthel and Functional Independence Measure (FIM) scales. Furthermore, in a group of 73 persons with chronic stroke we also carried out an overall evaluation, by using specific rating scales (FIM, Stroke Impact Scale, Motricity Index, Tinetti Balance Scale, 10-m Walking Test, 6-min Walking Test, 5 Repetitions Sit-to-Stand Test, and Hamilton Depression Scale) after 120 days (114 ± 6) from the end of the home rehabilitation program. The results highlighted a statistically significant improvement between T0 and T1 and a significant worsening between T1 and T2 (follow-up at 3 months). Hamilton Depression Scale is the only parameter that significantly improves both at the time T1 and T2. Territorial rehabilitation system should consider some fundamental aspects: centrality of the person and the individual health project; identification of specific and personalized rehabilitation plan and prognosis based on the results of a follow-up; ultra-specialization of interventions; multidisciplinary team; highlight of the emerging needs; and coordination of the different care pathways.