Effect of six-month standardized tertiary rehabilitation program on the activities of daily living in stroke patients with hemiplegia

BACKGROUND:At present,there are many studies on the rehabilitation therapy of stroke patients with hemiplegia,but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE:To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN:A clinical observation. SETTING:Department of Rehabilitation Medicine,Huashan Hospital of Fudan University. PARTICIPANTS:Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology,Shanghai Huashan Hosptial from January 1999 to June 2003,including 49 males and 33 females,40-80 years of age,with a mean age of(65±11) years old. Inclusive criteria:According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995,the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage,and confirmed by CT or MRI to be initial patients;They should be accorded with the following conditions,including within 1 week after stabilization of life signs,Glasgow coma score > 8 points,40-80 years of age,with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria:Patients were excluded due to active liver disease,liver and kidney malfunction,congestive heart failure,malignant tumor,history of dementia,failure in respiratory function,tetraplegia;cerebral infarction or cerebral hemorrhage for more than 3 weeks;unable to be followed up due to in other cities and provinces;psychiatric history;deafness and muteness. According to the will of the patients or their relatives,the patients who accepted the standardized rehabilitation program were enrolled as the treatment group(n =42),and the others as the control group(n =40). Approval was obtained from the ethical committee of the hospital. METHODS:All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation,the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period(within about 1 month after attack),the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology,once a day,45 minutes for each time,5 times a week;At middle period(about 1-3 months after attack),the patients received rehabilitative interventions in the rehabilitation ward or center,once to twice a day,30-45 minutes for each time,4-5 days a week;At late period(about 3-6 months after attack),the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community,relatives and volunteers,3-4 times a week,and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES:The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1,3 and 6 months after attack respectively. RESULTS:Totally 82 patients with acute stroke were enrolled,and 3 cases in the treatment group missed,including 2 cases died at 1 month after admission,and 1 case refused the follow up 10 days later,all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group(P < 0.01),and the score differences were also obviously higher than those in the control group(P < 0.01). The activities of daily living at admission and 1,3 and 6 months after admission in the treatment group were 22.50%,46.43%,75.95% and 89.52% of that of normal people respectively,and those in the control group were 17.09%,25.77%,43.38% and 55.00% respectively. The activities of daily living at admission and 1,3 and 6 months in the treatment group were 131.66%,180.17%,175.08% and 162.76% of those in the controlgroup. As compared with at admission,the percentage of the score difference to the total score at the ends of the 1st,3rd and 6th months were 23.93%,53.45% and 67.02% in the treatment group,while 8.67%,25.36% and 36.98% in the control group. CONCLUSION:Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.