Abstract
ObjectivesThe purpose of the present study was to examine the potential benefits of additional training in patients admitted to recovery phase rehabilitation ward using the data bank of post-stroke patient registry.Subjects and MethodsSubjects were 2507 inpatients admitted to recovery phase rehabilitation wards between November 2004 and November 2010. Participants were retrospectively divided into four groups based upon chart review; patients who received no additional rehabilitation, patients who were added with self-initiated off hours training, patients who were added with off hours training by ward staff, patients who received both self-initiated training and training by ward staff. Parameters for assessing outcomes included length of stay, motor/cognitive subscales of functional independent measures (FIM) and motor benefit of FIM calculated by subtracting the score at admission from that at discharge.ResultsParticipants were stratified into three groups depending on the motor FIM at admission (≦28, 29∼56, 57≦) for comparison. Regarding outcome variables, significant inter-group differences were observed in all items examined within the subgroup who scored 28 or less and between 29 and 56. Meanwhile no such trends were observed in the group who scored 57 or more compared with those who scored less. In a decision tree created based upon Exhaustive Chi-squared Automatic Interaction Detection method, variables chosen were the motor FIM at admission (the first node) additional training (the second node), the cognitive FIM at admission(the third node).ConclusionsOverall the results suggest that additional training can compensate for the shortage of regular rehabilitation implemented in recovery phase rehabilitation ward, thus may contribute to improved outcomes assessed by motor FIM at discharge.
Highlights
Stroke is one of primary debilitating events that affect health status and functional capacity, and is reportedly ranked second or third cause of mortality or condition leading to functional impairments in most developed countries [1]
In a decision tree created based upon Exhaustive Chi-squared Automatic Interaction Detection method, variables chosen were the motor functional independent measures (FIM) at admission additional training, the cognitive FIM at admission(the third node)
Overall the results suggest that additional training can compensate for the shortage of regular rehabilitation implemented in recovery phase rehabilitation ward, may contribute to improved outcomes assessed by motor FIM at discharge
Summary
Stroke is one of primary debilitating events that affect health status and functional capacity, and is reportedly ranked second or third cause of mortality or condition leading to functional impairments in most developed countries [1]. Recent advancement has made various therapeutic options including thrombolytic therapy, intravascular therapy or cerebral protective therapy available for stroke patients, that does not undermine the significance of rehabilitation for functional recovery It has been confirmed from previous randomized control trials (RCT) or systematic reviews that providing care in stroke units by multidisciplinary team comprising doctors, nurses, physiotherapist (PT), occupational therapist (OT) and speech therapist (ST) leads to improved clinical outcomes, such as long-term prognosis, activities of daily living at discharge, length of hospital stay [3,4]. In Japan recovery phase rehabilitation ward for patients took effect from the year 2000 and the 2006 revision for reimbursement enabled post stroke patients to receive a maximum of three hours rehabilitation per day by PT, OT and ST This unique type of ward restricts intake of patient only to medical conditions such as stroke, spinal injuries, head trauma, hip fractures or disuse syndrome. No studies so far had examined the effect of off hours training (self-initiated training, training by ward staff or both) in recovery phase rehabilitation wards uniquely introduced in Japan
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