Assessing Patient Needs for the Enhancement of Stroke Rehabilitation Services: A Customer Value Perspective

Author(s):  
Yu-Hsiu Hung ◽  
Yu-Ching Lin ◽  
Wan-Zi Lin ◽  
Pin-Ju Chen
Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lewis B Morgenstern ◽  
Emma Sais ◽  
Michael Fuentes ◽  
Nneka Ifejika ◽  
Xiaqing Jiang ◽  
...  

Background: Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke than non Hispanic whites (NHWs). Stroke rehabilitation is important for outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods: Consecutive stroke patients were identified for a three month time period as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine self-reported rehabilitation services. Descriptive statistics were used to describe the study population. Ethnic comparisons of rehabilitation services were made using chi-squared or Fisher’s exact tests. Results: Seventy-two subjects (50 MA, 22 NHW) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS (NHW-2.5, MA-3.0) did not differ significantly. There were no ethnic differences in the proportion of patients who were discharged home without rehabilitation services (p=0.9). Among those who received rehabilitation (n=48), the figure shows the distribution of the first place for services. NHWs were more likely to be discharged to inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to be receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions: In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.


2001 ◽  
Vol 57 (2) ◽  
pp. 32-40 ◽  
Author(s):  
L. A. Hale ◽  
C. J. Eales

This paper presents the opinions of expert physiotherapists on what constitutes optimal stroke rehabilitation in South Africa. Data were collected by the use of the Delphi technique. Consensus was reached after two rounds, and the respondents’ views are summarised and discussed within the framework of South African health care. Results showed that physiotherapy was felt to be very important after stroke, and the survey created a profile of the skills that physiotherapists may require in order to work in this field. However, no new or innovative methods by which appropriate rehabilitation services could be delivered in South Africa were generated by the survey.The Delphi technique is described and its use in this survey considered.


1998 ◽  
Vol 19 (S1) ◽  
pp. S38-S40
Author(s):  
L. Provinciali ◽  
M. Bartolini

Author(s):  
Olubukola Adebisi Olaleye ◽  
Talhatu Kolapo Hamzat

Rehabilitation after stroke is a process that plays an important role in improving and / or enhancing recovery beyond what would have occurred spontaneously. The choice of environment for provision of rehabilitation services, mode of organisation and delivery of services are pertinent to the outcome of rehabilitation. Yet limited information exists on the best way to organise stroke rehabilitation and the relative cost of such services. The involvement and empowerment of patients are inherent and integral to the rehabilitation process. Health policy should therefore be directed at the adoption of rehabilitation settings that stimulate the involvement of patients in their own rehabilitation process and at an affordable cost.


2008 ◽  
Vol 9 (2) ◽  
pp. 97-102 ◽  
Author(s):  
Richard I. Lindley

AbstractThe need for stroke rehabilitation will lessen if stroke incidence declines and acute stroke medical and surgical treatment improves. The burden of stroke will also lessen as effective rehabilitation services (stroke rehabilitation units) and interventions are widely implemented. Despite the considerable amount of evidence available, implementation has been slow. Improvement in stroke rehabilitation will require continued professional advocacy, supported by local and national audit and future focused research.


2017 ◽  
Vol 8 (4) ◽  
Author(s):  
Silke Francois ◽  
Viviane Van Casteren ◽  
Katrien Vanthomme ◽  
Liesbeth Borgermans ◽  
Dirk Devroey

This study examines which therapists are involved in the rehabilitation of stroke survivors in Belgium at different points in time. A nationwide registration of stroke patients was provided by 199 and 189 family physicians working in sentinel practices for the years 2009 and 2010 respectively. 326 patients who were diagnosed with stroke were included. Patients with paralysis/paresis received significant more physiotherapy after one month (63%) compared to non-paralysed patients (38%) (P=0.005). Residing in a nursing home was associated with higher proportions of patients receiving physiotherapy, both after one (P=0.003) and six (P=0.002) months. 31% of patients with aphasia were treated by a speech and language therapist after one month, which decreased after six months to 20%. After six months, the patients in a nursing home received significant more often speech and language therapy (P=0.004), compared to patients living at home. The proportion of patients receiving stroke rehabilitation services provided by physiotherapists, speech/language therapists and occupational therapists is rather low, especially 6 months after the critical event.


Author(s):  
Bruce K. Brady ◽  
Lynda McGahan ◽  
Becky Skidmore

Objectives: Given the resource-intensive nature of stroke rehabilitation, it is important that services be delivered in an evidence-based and cost-efficient manner. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of three rehabilitation services after stroke: stroke unit care versus care on another hospital ward, early supported discharge (ESD) services versus “usual care,” and community or home-based rehabilitation versus “usual care.”Methods:A systematic literature review of cost analyses or economic evaluations was performed. Study characteristics and results (including mean total cost per patient) were summarized. The level of evidence concerning relative cost or cost-effectiveness for each service type was determined qualitatively.Results:Fifteen studies met the inclusion criteria: three on stroke unit care, eight on ESD services, and four on community-based rehabilitation. All were classified as cost-consequences analysis or cost analysis. The time horizon was generally short (1 year or less). The comparators and the scope of costs varied between studies.Conclusions:There was “some” evidence that the mean total cost per patient of rehabilitation in a stroke unit is comparable to care provided in another hospital ward. There is “moderate” evidence that ESD services provide care at modestly lower total costs than usual care for stroke patients with mild or moderate disability. There was “insufficient” evidence concerning the cost of community-based rehabilitation compared with usual care. Several methodological problems were encountered when analyzing the economic evidence.


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