Ann Rehabil Med.  2020 Apr;44(2):101-108. 10.5535/arm.2020.44.2.101.

Dose-Response Effect of Daily Rehabilitation Time on Functional Gain in Stroke Patients

Affiliations
  • 1Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
  • 2Daejeon-Chungcheong Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
  • 3Daejeon-Chungcheong Regional Medical Rehabilitation Center, Chungnam National University Hospital, Daejeon, Korea

Abstract


Objective
To demonstrate the effect of daily treatment time on recovery of functional outcomes and how each type of rehabilitation treatment influences the improvement of subgroups of functional outcomes in stroke patients.
Methods
We conducted a retrospective study in 168 patients who were admitted to the Department of Rehabilitation Medicine between 2015 and 2016. Patients who experienced their first-ever stroke and unilateral lesions were included. All patients underwent conventional rehabilitation treatment, and each treatment was administered one to two times a day depending on individual and treatment room schedules. Based on the mean daily treatment time, patients were divided into two groups: a high-amount group (n=54) and low-amount group (n=114). Outcomes were measured through the Korean version of Modified Barthel Index (MBI), FuglMeyer Assessment of the upper extremity, Trunk Impairment Scale (TIS), and Berg Balance Scale (BBS) scores on admission and at discharge.
Results
The functional change and scores at discharge of MBI, TIS, and BBS were greater in the high-amount group than in the low-amount group. Among various types of rehabilitation treatments, occupational therapy training showed significant correlation with MBI, TIS, and BBS gain from admission to discharge.
Conclusion
The amount of daily mean treatment in post-stroke patients plays an important role in recovery. Mean daily rehabilitation treatment time seems to correlate with improved balance and basic activities of daily living after stroke.

Keyword

Rehabilitation; Hemiplegia; Cerebrovascular disorders; Gait

Reference

1. Khaw KT. Epidemiology of stroke. J Neurol Neurosurg Psychiatry. 1996; 61:333–8.
Article
2. Beech R, Ratcliffe M, Tilling K, Wolfe C. Hospital services for stroke care: a European perspective. Stroke. 1996; 27:1958–64.
3. Fang Y, Chen X, Li H, Lin J, Huang R, Zeng J. A study on additional early physiotherapy after stroke and factors affecting functional recovery. Clin Rehabil. 2003; 17:608–17.
Article
4. Wang H, Camicia M, Terdiman J, Mannava MK, Sidney S, Sandel ME. Daily treatment time and functional gains of stroke patients during inpatient rehabilitation. PM R. 2013; 5:122–8.
Article
5. Partridge C, Mackenzie M, Edwards S, Reid A, Jayawardena S, Guck N, et al. Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. Physiother Res Int. 2000; 5:230–40.
Article
6. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47:e98–e169.
Article
7. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a metaanalysis. Stroke. 2004; 35:2529–39.
8. Veerbeek JM, Koolstra M, Ket JC, van Wegen EE, Kwakkel G. Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: a meta-analysis. Stroke. 2011; 42:3311–5.
9. Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomized trial. Lancet. 1999; 354:191–6.
10. Richards CL, Malouin F, Wood-Dauphinee S, Williams JI, Bouchard JP, Brunet D. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Arch Phys Med Rehabil. 1993; 74:612–20.
Article
11. Cooke EV, Mares K, Clark A, Tallis RC, Pomeroy VM. The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis. BMC Med. 2010; 8:60.
Article
12. Schneider EJ, Lannin NA, Ada L, Schmidt J. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. J Physiother. 2016; 62:182–7.
Article
13. Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, et al. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence? Stroke. 2009; 40:e89–97.
Article
14. Lennon S, Ashburn A. The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists’ perspective. Disabil Rehabil. 2000; 22:665–74.
Article
15. Dobkin BH, Dorsch A. New evidence for therapies in stroke rehabilitation. Curr Atheroscler Rep. 2013; 15:331.
Article
16. Choi YI, Kim WH, Park EY, Kim EJ. The validity, reliability and discriminative index of the Korean version of Modified Barthel Index (K-MBI) in stroke patients. J Korea Acad Ind Coop Soc. 2012; 13:4119–25.
17. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, et al. Development of the Korean version of Modified Barthel Index (K-MBI): multi-center study for subjects with stroke. J Korean Acad Rehabil Med. 2007; 31:283–97.
18. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002; 16:232–40.
Article
19. Ko J, You Y. Reliability and responsiveness of the Korean version of the trunk impairment scale for stroke patients. J Korean Phys Ther. 2015; 27:175–82.
Article
20. Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004; 18:326–34.
Article
21. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88:559–66.
Article
22. Lohse KR, Lang CE, Boyd LA. Is more better? Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke. 2014; 45:2053–8.
Article
23. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008; 51:S225–39.
Article
24. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke. 1994; 25:808–13.
Article
25. Di Monaco M, Trucco M, Di Monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil. 2010; 24:543–54.
Article
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr