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: 1.22). 09/2012; 12(3):193-9. DOI: 10.1111/j.1479-8301.2012.00412.x
Source: PubMed

ABSTRACT Background:  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. Methods:  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. Results:  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. Conclusions:  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.

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    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.
    06/2013; 5(2):141–160. DOI:10.1002/wmh3.47


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Jun 2, 2014