Interprofessional Stroke Rehabilitation for Stroke Survivors Using Home Care

Abstract

Although many advances have been made in stroke prevention and management, stroke continues to be a prevalent and burdensome condition, particularly among older adults 1 . Stroke is the leading cause of adult disability and the third leading cause of death in Canada 2,3 . More than 50,000 Canadians experience a stroke each year and more than 300,000 (1% of the population) live with the ongoing effects 4,5 Following a sentinel stroke, there is a 20% chance of having another stroke within two years 6 . The costs of health care associated with stroke are staggering. Canadians spend a total of $3 million days per year in hospital because of the physical disability associated with ABSTRACT: Objective: To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. Methods: Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. Results: A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI -7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p = 0.76). Conclusions: A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229 RÉSUMÉ: Réadaptation interprofessionnelle à domicile suite à un accident vasculaire cérébral. Objectif : Le but de notre étude était de comparer une approche utilisant une équipe interprofessionnelle spécialisée pour la réadaptation communautaire au moyen de services à domicile, suite à un accident vasculaire cérébral (AVC). Méthode: Nous avons effectué un essai contrôlé randomisé chez 101 patients ayant subi un AVC moins de 18 mois auparavant, qui vivaient dans la communauté et utilisaient des services de soins à domicile. Les...

Increasing comorbidity and health services utilization in older adults with prior stroke

“…At the same, though, it has been well-reported that older adults who experience a stroke often live with long-term functional impairments. 29,30 Although we cannot speculate based on our data, others have demonstrated ongoing unmet needs for supportive home care services for stroke survivors. 31 We found that the drivers of health care costs varied by the number of comorbid conditions.…”

Rehabilitation Interventions for Improving Social Participation After Stroke

“…Of interest, removing the only study 41 that did not involve face-to-face contact resulted in a near significant effect, suggesting that the act of leaving the house and interacting in-person with others may need to be an active ingredient of a social participation intervention. It is important to note that participants only received usual care (and not an attention control) in four 25,31,33,35 out of five studies that showed that support service was more beneficial, and thus, it is not possible to disentangle the effects of attention versus support.…”

“…One study each reported that no adverse events 25 and no serious adverse events occurred. 37 Seventeen studies [22][23][24]26,27,[29][30][31][32][33][34][35][36]39,[43][44][45] , including ten with exercise components, did not state whether any adverse events occurred or not.…”

Multidisciplinary care for stroke patients living in the community: A systematic review

“…In 12 studies patients were included immediately after discharge home from hospital, in 1 trial patients were included ≥ 18 months post-stroke (33) and in another trial patients were included after discharge from a rehabilitation centre (35). the period between stroke occurrence and discharge was described by only 3 out of 14 studies (29,35,37), varying from a mean of 45 days (37) to 2.5 years (33).…”

“…the assessments were performed at 1 month (38) or 5-6 months after discharge home (29). the second type of intervention (assessment combined with follow-up care) could be subdivided into assessment with either subsequent follow-up visits (n = 5) (25,26,28,33,34) or assessment with subsequent rehabilitation (n = 3) (30-32). the 5 assessments with follow-up visits were aimed at coping with the consequences of stroke (28) and improving the quality of life (33,34).…”