Randomized Controlled Trial of Home Rehabilitation for Patients With Ischemic Stroke: Impact Upon Disability and Elderly Depression

Faculty of Physical Therapy, Mahidol University, Nakhon Pathom Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Psychogeriatrics (Impact Factor: 0.99). 09/2012; 12(3):193-9. DOI: 10.1111/j.1479-8301.2012.00412.x
Source: PubMed


Patients with major stroke are often left with disability and may have depression and dementia during the recovery phase. Rehabilitation programmes have been shown to improve short-term physical outcome, but their long-term effectiveness and impact on dementia and depression are uncertain.

We performed a 6-month randomized controlled trial of a home rehabilitation programme and compared it with the standard care patients with recent ischemic stroke receive. The intervention group received home-based physical therapy once a month for 6 months, along with educational support, counselling and audiovisual materials. The control group received rehabilitation as prescribed by a physician and educational materials upon discharge from hospital. The primary measurement was a change in Barthel Index. Secondary measurements were the Hospital Anxiety and Depression Scale (HADS) and Thai Mini-Mental State Examination.

Of the 68 screened patients, 60 patients were enrolled. At baseline, there was no significant difference in patient characteristics between the two groups. Over 2 years, the mean Barthel Index and Hospital Anxiety and Depression Scale were significantly improved in the intervention group compared to the control group (Barthel Index mean: from 31.7 ± 5.9 to 97.2 ± 2.8 vs from 33.2 ± 4.8 to 76.4 ± 9.4, P < 0.001; Hospital Anxiety and Depression Scale mean: from 16.1 ± 7.6 to 9.1 ± 0.3 vs 16.4 ± 4.9 to 9.1 ± 0.3, P= 0.003). Depression was strongly associated with being dependent on others. However, the Thai Mini-Mental State Examination in both groups did not significantly differ (Thai Mini-Mental State Examination mean: from 24.4 ± 2.0 to 24.6 vs 23.8 ± 1.9 to 24.1 ± 0.3, P= 0.068). There was no significant interaction between baseline characteristics and treatment outcome.

At 2 years follow-up, it was evident that a 6-month home rehabilitation programme after ischemic stroke improved functional outcome and reduced incidence of depression, but not dementia.

Download full-text


Available from: Kongkiat Kulkantrakorn,
    • "Rehabilitation in the home appears to be effective (Ashworth et al., 2005; Asiri et al., 2014; Chaiyawat & Kulkantrakorn, 2012; Cook et al., 2013; Madigan et al., 2012; Tinetti et al., 2002; Whitney et al., 2013) but it is not clear what type of exercise programs are optimal for specific patient groups. Cook et al. reported that persons treated in the home (n = 99,764) who had activities of daily living (ADL) deficits at onset improved their ADL scores, had lower mortality rates, and were less likely to be institutionalized via use of the Resident Assessment for Home Care Assessment tool. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A retrospective cohort study with adjustment for baseline group differences was conducted to determine if there was a difference in Outcome and Information Data Set (OASIS-C) activities of daily living (ADL) outcomes as well as the duration and number of home care visits between usual home care rehabilitation services and a home care rehabilitation team that was specially trained in falls identification and prevention. Data from adult Medicare beneficiaries who were treated in a large multistate home care practice with at least one visit by a physical therapist were retrieved retrospectively for analysis (n = 3,907 records). Patients identified as having multiple fall risk factors based on OASIS-C assessment undergoing a specialized care program demonstrated greater improvements in mean total ADL scores after home healthcare rehabilitation services compared with subjects at fall risk receiving usual care. Interdisciplinary care delivered by a healthcare team specially trained in fall prevention appeared to decrease the number of home care visits and resulted in improved ADL OASIS-C outcome scores after adjustment for potential confounders.
    05/2015; 33(5):265-74. DOI:10.1097/NHH.0000000000000232
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the changing landscape of global health, new challenges continuously emerge and new ways of addressing them are needed. There are huge discrepancies between health care services in high- and low-income countries, and their ability to deal with these health challenges. Physical inactivity is recognised as a growing and serious problem for global health. Physical therapy – an allied health profession primarily interested in function and movement of the human body – is well established and recognised in most high-income countries. In low- and middle-income countries, however, physical therapists are either severely limited in numbers and inaccessible to most, or services are established largely outside of national health systems. Yet in these countries, physical therapists can have a major role to play from promotion and prevention to habilitation and rehabilitation. Using physical activity as its underpinning approach, there are clear gaps to fill within the spheres of non- communicable disease, maternal and child health, aging populations, HIV/AIDS, musculoskeletal disorders and injuries and mental health, to name a few. Thus in this discussion paper we propose that, as a component of collaborative interdisciplinary care and with contextually adapted and locally rooted services, physical therapy is an important health profession for health systems in low-income countries.
    World Medical and Health Policy 06/2013; 5(2):141–160. DOI:10.1002/wmh3.47
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Neurorestoration of motor command in spastic paresis requires a double action of stimulation and guidance of central nervous system plasticity. Beyond drug therapies, electrical stimulation and cell therapies, which may stimulate plasticity without precisely guiding it, two interventions seem capable of driving plasticity with a double stimulation and guidance component: the lesion itself (lesion-induced plasticity) and durable behavior modifications (behavior-induced plasticity). Modern literature makes it clear that the intensity of the neuronal and physical training is a primary condition to foster behavior-induced plasticity. When it comes to working on movement, intensity can be achieved by the combination of two key components, one is the difficulty of the trained movement, the other is the number of repetitions or the daily duration of the practice. A number of recent studies shed light on promising recovery prospects, particularly using the emergence of new technologies such as robot-assisted therapy and concepts such as guided self-rehabilitation contracts. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Revue Neurologique 01/2015; 171(2). DOI:10.1016/j.neurol.2014.09.011 · 0.66 Impact Factor