Effectiveness of community rehabilitation for chronic stroke patients—effect factors of outpatient rehabilitation class

Abstract

Background: After the introduction of Long-Term Care Insurance Act in 2000, in-home service policy in medical and welfare fields has been clarified in Japan. Community rehabilitation has come to be actively carried out. Due to the medical fee revision of 2006, which restricted the number of days of rehabilitation, rehabilitation for chronic patients using medical insurance has become difficult. In Japan, there are few places for the community rehabilitation to match the needs of chronic stroke patients, and the effective method has not been established for them. Purpose(s): We are carrying out outpatient rehabilitation class for home chronic stroke patients in N City. The purpose is to evaluate the results of our intervention from 2012 to 2013, and to assess the effect factors of community rehabilitation. Method(s): The subjects were 15 patients (3 females, 12 males, mean age 61.8+/-6.3years). Characteristic features included chronic stroke (motor paralysis, higher brain dysfunction such as aphasia, and apraxia). For the class management, four occupational therapists or physiotherapists are in charge in turn. Each therapist held group programs for about 2 hours once a week, and the programs include recreation that incorporates seasonal events and physical exercises. PT/OT students participated 10 times of 48 times a year. Effect measurements were carried out in the questionnaire survey and physical function evaluation. Items of the survey are physical function (degree of paralysis, sensation, muscle strength, range of motion, higher brain function), activities of daily living (TMIG Index of Competence, Barthel Index), and a condition of willingness (Vitality Index). As for the participants that had difficulty writing, their family wrote it for them. Result(s): Analysis subjects were 11 patients (10 males, one female). To clarify the effect of the class for one year, a comparison of before and after the implementation was made using the code Wilcoxon rank sum test. There was no significant difference in TMIG (p-value = 0.529), BI (p-value = 0.917), and VI (pvalue = 0.933). These results showed that the each function was maintained. From the survey results, the subjective effects were classified into the following categories, "intermingling", "group", "recovery". "Intermingling" were classified into subcategories of student, family, PT/OT. Furthermore the terms indicating the contents included extent of idea, information exchange, energy, and vitality. The terms indicating the contents in the category of "group" included fun, helping each other, stimulating, encouraging, struggling, no hesitation, and chatter. Conclusion(s): The result indicated that the intervention effect of the class came from the role feeling they got from interaction with students, and the stimulus of having to work with participants with similar symptoms. There are difficulties in social participation caused by difficulty understanding the circumstances and difficulty communicating due to higher brain dysfunction. However, now it is thought that if there is a role and a class to participate, patients can spend motivated home lives and maintain their functions. Implications: The community rehabilitation using "intermingling" and "role feeling" was to be useful for chronic stroke patients.