Article

OBJECTIVE: To examine the effect of duration, participation rate, and supervision
during community rehabilitation on functional outcome during the first poststroke year. DESIGN: Prospective longitudinal study with interviews at admission,
discharge, 1 month, 6 months, and 1 year after discharge. SETTING: Two subacute
inpatient rehabilitation units and the community after discharge in Singapore.
PARTICIPANTS: Subacute nonaphasic stroke patients (N=215). INTERVENTION:
Participation rate in supervised therapy (at an outpatient rehabilitation center)
and unsupervised therapy (at home) as defined as proportion of time performing
therapy as prescribed by the subacute hospital's multidisciplinary rehabilitation
team at discharge. MAIN OUTCOME MEASURE: Performance of activities of daily
living as measured by Barthel Index (BI) score at 1 year and improvement in BI
scores between adjacent timepoints. RESULTS: At 1 month after discharge, 33.3%
were performing supervised therapy more than 25% of the recommended time, and
66.3% of subjects were performing unsupervised therapy more than 75% of the
recommended time. On a mixed-model analysis, the independent predictors of lower
BI scores were older age, hypertension, greater cognitive impairment, greater
depressive symptoms, and greater neurologic impairment. Adjusting for these
independent factors, performance of supervised therapy at 1 (beta=8.8; 95%
confidence interval [CI], 0.5-17.0; P=.039) and 6 (beta=20.1; 95% CI, 11.0-29.2;
P<.001) months postdischarge, but not unsupervised therapy, predicted better BI
score at 1 year. Those who performed supervised therapy more than 25% of the
recommended time achieved their maximal functional recovery faster than those who
performed supervised therapy 25% or less of the recommended time (1 mo vs 6 mo).
CONCLUSIONS: Supervised stroke rehabilitation in the community at 1 and 6 months
was associated with better functional status at 1 year than unsupervised therapy,
and a higher participation rate in supervised therapy was associated with greater
and faster functional recovery.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS