Application effect of the hospital-community integrated service model in home rehabilitation of stroke in disabled elderly: a randomised trial

Abstract

Background: Disabled elderly with stroke usually have difficulty in obtaining professional rehabilitation intervention after being discharged from the hospital, and their self-health management ability is low, so their illness is prone to relapse. The hospital community-integrated service model (HCISM) is a scientific model designed to meet the needs of home care after discharge from the hospital, improve the quality of life of patients after discharge from the hospital, ease the burden on the family, and improve the service capabilities of community medical staff. The purpose of this study is to explore the effect of HCISM in home rehabilitation of stroke disabled elderly.Methods: From September 2019 to September 2020, 120 the disabled elderly patients with stroke admitted to Affiliated hospital of Jiangnan University were selected and divided into two groups with a random number table method, with 60 cases in each group. Both groups underwent home rehabilitation after discharge, the control group was given routine intervention, and the observation group was given HCISM intervention. The changes of self-care ability, compliance behavior, self-efficacy, and adverse mood before and after intervention were compared between the two groups.Results: The modified Barthel Index (MBI) score of the observation group after 3 months of intervention was higher than that of the control group (P<0.05). In the observation group, the changes in the proportion of medication, reasonable diet, moderate exercise, and regular return visits after 3 months were higher than those in the control group (P<0.05). The General Self-efficacy Scale (GSES) score of the observation group was higher than that of the control group after 3 months of intervention (P<0.05). Zung's Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores in the observation group were low after 3 months of intervention than those in the control group (P<0.05).Conclusions: HCISM applied to the home rehabilitation of the disabled elderly patients with stroke can improve life self-care ability and self-efficacy, improve medical compliance behavior, and reduce negative emotions, thus making it worthy of further promotion.

Interventions within the Scope of Occupational Therapy in the Hospital Discharge Process Post-Stroke: A Systematic Review

“…Of the 13 studies included in the review, 6 of them included the role of the occupational therapist and were conducted in Denmark, Sweden, Germany, Norway, and South Africa, highlighting the resurgent importance of occupational therapy in Northern European countries [ 42 , 43 , 44 , 45 , 46 , 47 ]. However, of the seven included studies that did not name OT, six of them were conducted in China [ 48 , 49 , 50 , 51 , 52 , 53 ] and one in Australia [ 54 ]. The year of publication of the studies varies, with 2016 the year when more studies were published (three of them), followed by 2019, 2020, and 2021, with two studies published in each of these years.…”

“…Occupational therapy in stroke involves working with the patient, the caregiver, and the family unit. All of the interventions focused on improvements in the functional ability of the person with stroke (n = 1803), whereas the caregiver was considered an important factor in patient rehabilitation in 85% of studies (the study included, for example, the psychoeducation of the caregiver with the aim of improving knowledge, skills, and confidence) [ 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].…”

“…The included studies investigated the effectiveness of the following interventions in the discharge process of stroke patients: Coordination in the process of transition from hospital to home [ 42 , 45 , 47 , 48 , 50 , 51 ]. Home evaluation and adaptation [ 45 , 52 ].…”

“… Functional rehabilitation [ 44 ]. Recommendations, guidance, and counselling [ 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 ]. Stroke prevention [ 45 , 46 ].…”

“… Stroke prevention [ 45 , 46 ]. Information on referrals to other therapeutic services [ 44 , 45 , 49 , 51 ]. Educational sessions [ 46 ].…”