Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial
Tóm tắt
Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people. About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, which can lead to difficulties in picking up and managing their social life. The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients. A two group multicentre randomised controlled trial is used to evaluate the effects of the rehabilitation programme. The programme consists of three care modules: 1) neurorehabilitation treatment for elderly stroke patients; 2) empowerment training for patient and informal caregiver; and 3) stroke education for patient and informal caregiver. The total programme has a duration of between two and six months, depending on the individual problems of the patient and informal caregiver. The control group receives usual care in the nursing home and after discharge. Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge. Data are gathered by face-to-face interviews, self-administered questionnaires, focus groups and registration forms. Primary outcomes for patients are activity level after stroke, functional dependence, perceived quality of life and social participation. Outcomes for informal caregivers are perceived care burden, objective care burden, quality of life and perceived health. Outcome measures of the process evaluation are implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. Outcome measures of the economic evaluation are the healthcare utilisation and associated costs. Data are collected at baseline, and after six and 12 months. The first results of the study will be expected in 2014. International Standard Randomised Controlled Trial Register Number ISRCTN62286281, The Dutch Trial Register NTR2412
Tài liệu tham khảo
Weimar C, Kurth T, Kraywinkel K, Wagner M, Busse O, Haberl RL, Diener HC: German Stroke Data Bank Collaborators: Assessment of functioning and disability after ischemic stroke. Stroke. 2002, 33 (8): 2053-2059. 10.1161/01.STR.0000022808.21776.BF.
Mackay J, Mensah G: Atlas of Heart Disease and Stroke. 2004, Geneva: World Health Organization
Vaartjes I, van Dis I, Visseren FLJ, Bots ML: Incidentie en prevalentie van hart- en vaatziekten in Nederland. Hart- en vaatziekten in Nederland 2010, cijfers over leefstijl- en risicofactoren, ziekte en sterfte. Edited by: Vaartjes I, Dis I, Visseren FLJ, Bots ML. 2010, Den Haag: Nederlandse Hartstichting
Gommer AM, Poos MJJC: Beroerte: prevalentie, incidentie en sterfte naar leeftijd en geslacht. Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. 2011, Bilthoven: RIVM
Schols JMGA, Crebolder HFJM, Van Weel C: Nursing Home and Nursing Home Physician: The Dutch Experience. JAMDA. 2004, 5 (3): 207-212.
Eyck A, Peerenboom PB: Revalidatie in Nederland. De grenzen van AWBZ en ZVW. 2006, Leusden: ETC. TANGRAM
Landelijke Medische Registratie (PRISMANT). 2004
Huijsman R, Klazinga NS, op Reimer WJM S, Van Wijngaarden JDH, Van Exel NJA, Van Putte-Boon C, Prestholt FT, Koopmanschap MA, Niessen LW: Results of the EDISSE study of three regional experiments with stroke services. Report ZonMW. 2001
Lincoln NB, Gladman JR, Berman P, Noad RF, Challen K: Functional recovery of community stroke patients. Disabil Rehabil. 2000, 22 (3): 135-139. 10.1080/096382800296980.
Desrosiers J, Noreau L, Rochette A, Bravo G, Boutin C: Predictors of handicap situations following post-stroke rehabilitation. Disabil Rehab. 2002, 24 (15): 774-785. 10.1080/09638280210125814.
Dijkerman HC, Wood VA, Hewer RL: Long-term outcome after discharge from a stroke rehabilitation unit. J R Coll Physician Lond. 1996, 30 (6): 538-546.
Peerenboom PBG, Spek J, Zekveld I, Cools HJM, van Balen R, Hoogenboom MJ: Revalidatie in de AWBZ, omvang, aard en intensiteit. 2008, Tangram/LUMC: ETC
Cramer SC: Changes in motor system function and recovery after stroke. Restor Neurol Neurosci. 2004, 22 (3–5): 231-238.
D’Alisa S, Baudi S, Mauro A, Miscio G: How does stroke restrict participation in long-term post-stroke survivors?. Acta Neurol Scand. 2005, 112 (3): 157-162. 10.1111/j.1600-0404.2005.00466.x.
Murray J, Ashworth R, Forster A, Young J: Developing a primary care-based stroke service: a review of the qualitative literature. Br J Gen Pract. 2003, 53 (487): 137-142.
Morrison V, Pollard B, Johnston M, MacWalter R: Anxiety and depression 3 years following stroke: demographic, clinical, and psychological predictors. J Psychosom Res. 2005, 59 (4): 209-213. 10.1016/j.jpsychores.2005.02.019.
Rasquin SM, Lodder J, Ponds RW, Winkens I, Jolles J, Verhey FR: Cognitive functioning after stroke: a one-year follow-up study. Dement Geriatr Cogn Disord. 2004, 18 (2): 138-144. 10.1159/000079193.
van Heugten C, Visser-Meily A, Post M, Lindeman E: Care for carers of stroke patients: evidence-based clinical practice guidelines. J Rehabil Med. 2006, 38 (3): 153-158. 10.1080/16501970500441898.
Bollars S, van Erp J, Fens M, van Gorp E, van Hoppe J, Krikke T, de Meris J, Notz B, van der Ven A, Vluggen T, Benjaminsen S: Uitbehandeld! Hoezo?. 2012, Kennisnetwerk CVA Nederland: Een leidraad in het doolhof van zorg in de chronische fase na een CVA
Bull MJ: Managing the transition from hospital to home. Qualitative Health Res. 1992, 2: 27-41. 10.1177/104973239200200103.
Cott CA, Wiles R, Devitt R: Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil. 2007, 29 (20–21): 1566-1574.
Boter H, Rinkel GJ, de Haan RJ: HESTIA Study Group. Outreach nurse support after stroke: a descriptive study on patients' and carers' needs, and applied nursing interventions. Clin Rehabil. 2004, 18 (2): 156-163. 10.1191/0269215504cr713oa.
Turner-Stokes L, Hassan N: Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 1: Diagnosis, frequency and impact. Clin Rehabil. 2002, 16 (3): 231-247. 10.1191/0269215502cr487oa.
Landi F, Onder G, Cesari M, Zamboni V, Russo A, Barillaro C, Bernabei R: The Silvernet-HC study group: Functional decline in frail community-dwelling stroke patients. Eur J Neurol. 2006, 13 (1): 17-23. 10.1111/j.1468-1331.2006.01116.x.
Aziz NA, Leonardi-Bee J, Phillips M, Gladman JR, Legg L, Walker MF: Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev. 2008, 16 (2): CD005952-
Outpatient Service Trialists: Therapy-based rehabilitation services for stroke patients at home. Cochrane Database Syst Rev. 2003, CD002925-1
Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, Gonzalez VM, Laurent DD, Holman HR: Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001, 39 (11): 1217-1223. 10.1097/00005650-200111000-00008.
Rockwood K, Stolee P, Fox R: Use of goal attainment scaling in measuring clinically important change in the frail elderly. J Clin Epidemiol. 1993, 46 (10): 1113-1118. 10.1016/0895-4356(93)90110-M.
Walker MF, Leonardi-Bee J, Bath P, Langhorne P, Dewey M, Corr S, Drummond A, Gilbertson L, Gladman JR, Jongbloed L, Logan P, Parker C: Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients. Stroke. 2004, 35 (9): 2226-2232. 10.1161/01.STR.0000137766.17092.fb.
Fjaertoft H, Indredavik B, Lydersen S: Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial. Stroke. 2003, 34 (11): 2687-2691. 10.1161/01.STR.0000095189.21659.4F.
Jones F: Strategies to enhance chronic disease self-management: how can we apply this to stroke?. Disabil Rehabil. 2006, 28 (13–14): 841-847.
Schuling J, de Haan R, Limburg M, Groenier KH: The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke. 1993, 24 (8): 1173-1177. 10.1161/01.STR.24.8.1173.
Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS: Comparing proxy and patients' perceptions of patients' functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc. 1992, 40 (6): 585-588.
Williams LS, Weinberger M, Harris LE, Biller J: Measuring quality of life in a way that is meaningful to stroke patients. Neurology. 1999, 53 (8): 1839-1843. 10.1212/WNL.53.8.1839.
Cardol M, de Haan RJ, van den Bos GA, de Jong BA, de Groot IJ: The development of a handicap assessment questionnaire: the Impact on Participation and Autonomy (IPA). Clin Rehabil. 1999, 13 (5): 411-419. 10.1191/026921599668601325.
Brouwer WB, NJ v E, van GB, Redekop WK: The CarerQol instrument: a new instrument to measure care-related quality of life of informal caregivers for use in economic evaluations. Qual Life Res. 2006, 15 (6): 1005-1021. 10.1007/s11136-005-5994-6.
van den Berg B, Spauwen P: Measurement of informal care: an empirical study into the valid measurement of time spent on informal caregiving. Health Econ. 2006, 15 (5): 447-460. 10.1002/hec.1075.
van der Zee K, Sanderman R: Het meten van de algemene gezondheidstoestand met de rand-36, een handleiding. 2002
Folstein MF, Folstein SE, McHugh PR: Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.
Saunders RP, Evans MH, Joshi P: Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract. 2005, 6 (2): 134-147. 10.1177/1524839904273387.
Oostenbrink AM, Koopmanschap MA, Rutten FFH: Handleiding voor kostenonderzoek, methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. 2004, Amstelveen: College voor zorgverzekeringen
Schuling J, de Haan R, Limburg M, Groenier KH: The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke. 1993, 24 (8): 1173-1177. 10.1161/01.STR.24.8.1173.
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