Ann Rehabil Med.  2019 Oct;43(5):581-591. 10.5535/arm.2019.43.5.581.

Effectiveness of Family-Engaged Multidimensional Team Planning and Management for Recovery in Patients With Severe Stroke and Low Functional Status

Affiliations
  • 1Research Institute of Health and Welfare, Kibi International University, Takahashi, Japan. hiragami@kiui.ac.jp
  • 2Department of Occupational Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan.

Abstract


OBJECTIVE
To evaluate the effectiveness of family-engaged multidimensional team planning and management for patients with severe stroke and low functional status and to identify factors predictive of improved outcome at 1 month after admission.
METHODS
We retrospectively evaluated 50 patients who underwent family-engaged multidimensional rehabilitation for recovery from severe stroke due to primary unilateral cerebral lesions. The rehabilitation consisted of three phases: comprehensive multidimensional assessment, intensive rehabilitation, and evaluation. Functional Independence Measure (FIM) scores were calculated and used to predict the patients' status at discharge.
RESULTS
Although all FIM scores significantly improved after 1 month of rehabilitation, the motor FIM (mFIM) score improved the most (from 20.5±1.0 to 32.6±2.0). The total FIM (tFIM) and mFIM scores continued to improve from the first month to discharge (mean mFIM efficiency, 0.33). The high-efficiency patient group (mFIM efficiency ≥0.19) had a significantly higher discharge-to-home rate (44% vs. 13%), lower frequency of hemispatial neglect, and more severe finger numbness than the low-efficiency patient group (mFIM efficiency <0.19). The regression analyses revealed that besides lower mFIM and cognitive FIM scores at admission, unilateral spatial neglect, systemic comorbidities, and age were predictive of worse 1-month outcomes and tFIM scores (conformity, R²=0.78; predictive power, Akaike information criterion value=202).
CONCLUSION
Family-engaged multidimensional team planning and management are useful for patients with severe stroke and low functional status. Furthermore, FIM scores at admission, age, unilateral spatial neglect, and systemic comorbidities should be considered by rehabilitation teams when advising caregivers on the probability of favorable outcomes after rehabilitation.

Keyword

Stroke; Cerebrovascular disorders; Symptom assessment; Rehabilitation; Dependency

MeSH Terms

Caregivers
Cerebrovascular Disorders
Comorbidity
Fingers
Humans
Hypesthesia
Perceptual Disorders
Rehabilitation
Retrospective Studies
Stroke*
Symptom Assessment
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error