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Høyer E.1, Opheim A.2, Strand L.I.3
1Sunnaas Rehabilitation Hospital, Department of Brain Injury and Department of Research, Nesoddtangen, Norway, 2Sunnaas Rehabilitation Hospital, Department of Research, Nesoddtangen, Norway, 3University of Bergen, Department of Public Health and Primary Health Care, Bergen, Norway
Background: Maintenance of outcome after specialized rehabilitation concerns both the effectiveness of inpatient rehabilitation and of follow-up in the community. Sixty patients with severe stroke participated in the RCT-study: “Body weight supported treadmill training versus traditional training in patients dependent of walking assistance after stroke: a randomized controlled trial” (Høyer 2012).The randomized groups improved clinically and statistically significant during specialized rehabilitation, but did not demonstrate difference in outcome. We were concerned about their further functional development after being discharged from the hospital, and decided to investigate health and functional aspects in a long-term perspective.
Purpose: To investigate whether health related quality of life and whether abilities of walking and transfer remained stable or changed after discharge in patients with stroke after a long period of community living.
Methods: Questionnaires were used to investigate demographic conditions, walking and transfer functions and health related quality of life. The patient´s physiotherapist answered questions concerning the patients home conditions, assistance in daily life, mobility, walking and transfer. Assessment tools were Functional Ambulation Categories (FAC,1-5, Holden et al. 1984, Holden et al. 1986, Wade 1995), EU-Walking (Maegele et al.2002), 10m walk test (Butland et al. 1982,Wade et al.1987, Collen et al. 1990), and Functional Independence Measure (FIM 1-7, shorter transfer and stairs). The patient answered the SF-36 Questionnaire about health (Ware 1992, Loge 1998) concerning physical, psychological and social domains. Descriptive statistics and nonparametric tests (Wilcoxon Signed Rank Test) were used to describe and to compare ordinal data. Parametric tests (Paired samples t-test) were used to compare continuous data.
Results: Forty-seven persons (78%) responded; 4 were confirmed not alive and 9 did not respond. The mean time for follow-up was 16.4 months, minimum 6.5 months, max 5.7 years after discharge from rehabilitation. All persons lived in their private homes, except two who needed extra care. Forty persons were reported to receive physiotherapy, occupational therapy and/or speech therapy. Thirty-one persons had one to four (one seven) periods of rehabilitation stays. Most persons (n=42) were still not working. A larger proportion, 53%, did not use a wheelchair compared to 23% at discharge. Dependence of walking assistance decreased as assessed by FAC. Walking speed increased significantly by 0.25 m/s. Ability of shorter transfer and climbing stairs remained stable. Twenty-nine patients (64%) considered their health status as good to excellent, while only four reported bad. Thirty-two persons (71%) evaluated their own health as better, 7 as stable and 6 as worse compared to one year earlier. Physical activities that require muscle strength and endurance were experienced to be substantially restricted by the majority.
Conclusion(s): The majority of persons who participated in the follow-up study, demonstrated substantial progression in important aspects of health and functioning. The majority had received physiotherapy and one or more rehabilitation stays. However, there was much variability in the change scores, and some persons did not demonstrate any improvements.
Implications: Persons with severe stroke after specialized rehabilitation may seem to have substantial, but variable potential for functional improvement when appropriate and individualized treatment is offered in the community.
Funding acknowledgements: The authors want to thank the South-Eastern Norway Regional Health Authority for financial research support.
Topic: Neurology: stroke
Ethics approval: The study was approved by the South-East regional committee for research ethics in Norway (ref:108-04043).
All authors, affiliations and abstracts have been published as submitted.
