Abstract TP148: Characteristics and Estimated Rehabilitation Costs for Stroke Survivors Treated in a Community-Based Interdisciplinary Outpatient Rehabilitation Program Who Return to Work

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joan Breen ◽  
Jeanne Andrusin ◽  
Tom Ferlito ◽  
Samantha Hobbs
Keyword(s):  
Return To Work ◽  
Treatment Cost ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Patient Centered ◽  
Rehabilitation Programs ◽  
Length Of Treatment ◽  
Returning To Work

Background: Return to work is a motivating goal for many stroke survivors. Little is known about the cost, length of treatment, and characteristics of patients returning to work. Methods: Prospective observational study of stroke patients treated between 12/2014-6/2016 in an interdisciplinary outpatient rehabilitation program addressing physical, psychosocial, cognitive, communicative, driving, and vocational issues. The estimated average cost of treatment was calculated from reimbursement amounts received for skilled PT, OT, ST, and Nurse Practitioner services, including services received after patients returned to work. Results: Of 96 consecutive patients, 48% were working prior to their stroke. Of these, 9% of patients were work capable and 44% returned to work (n=20) by rehabilitation discharge (mean program length was 8 months, maximum of 34 months). Returning workers were 70% men, mean age of 56 years, 75% ischemic strokes (4 Left, 4 Right, 3 Bi-lateral hemisphere, 4 posterior circulation), and on program admit had an average NIHSS score of 3.4 (range 0-9), 40% were aphasic, 65% needed ADL assistance (55% mRS=3, 10% mRS=4). All patients working prior to their stroke were also driving and 90% of those who returned to work also returned to driving. All patients demonstrated improvements in multiple standardized rehab outcome measures. Mean treatment cost for patients who returned to work was $17,730 (60% had costs less than $7,500; 25% had costs from $7,501-$21,000; 15% had costs from $50,000-$92,000). Services continued for 75% of patients after returning to work for an average of 3.7 months(included in mean program length of 8 months). Almost half of these patients (47%) were aphasic. Mean treatment cost for patients not returning to work was $22,561, with mean program length of 6.5 months. Conclusions: These findings demonstrate that interdisciplinary, outpatient rehabilitation programs can promote successful return to work at a reasonable cost, with 60% of patients who returned to work costing less than $7500. Aphasic patients needed longer treatment, but were able to successfully return to work. Additional outcomes research is needed to understand mechanisms supporting stroke patients’ return to work and other patient-centered goals.

Abstract P209: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Return to Work Outcomes: Characteristics and Rehabilitation Outcomes of Stroke Survivors Who Return to Work

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Joan C Breen
Keyword(s):  
Return To Work ◽  
Average Length ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Stroke Survivors ◽  
Patient Centered ◽  
Nihss Score ◽  
Successful Recovery ◽  
Percent Improvement ◽  
Returning To Work

Background: Return to employment and driving are goals for many stroke survivors. There are few reports of patient centered outcomes like return to work or the characteristics of those who achieve these goals. Methods: Prospective observational study of stroke patients treated between 12/2011-7/2019 in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive/communicative, risk factors, psychosocial, driving and vocational issues. Results: Of 190 consecutive patients,104(55%) were working prior to their stroke. 50% (73% men, 27% women) of those working pre-stroke returned to work upon program completion with 90% returning to their prior job, and 65% at prior hours. 24% of returning workers owned their own business, and 76% had other occupations. Returning workers had average age of 54 years, average NIHSS score of 4(range 0-11), average{mRS} of 2.7 (6% with 1; 25% with 2; 58% with 3; 10% with 4), and 31% were aphasic. 39 suffered ischemic strokes and 13 had hemorrhages. Locations were: 18 Left, 15 Right,11 Bilateral hemisphere, 8 Brainstem). 93% of patients working pre-stroke were driving. 80% who returned to work also resumed driving. Returning workers had average percent improvement in 6” walk and Berg Balance scores of 97% and 50% respectively; this group also improved in all 9 Stroke Impact scale domains with SIS total score improving an average of 22%. In comparison, of those not returning to work 34 had ischemic strokes, 18 had hemorrhages. This group had average age 55.6, average NIHSS score 7.3(range2-16), average {mRS} of 3.3(11% with 2, 54% with 3, 33% with 4, 2% with 5), 42% were aphasic, and 20% resumed driving. Returning workers had average admit Montreal Cognitive Assessment score of 25/30 and Stroke Self Efficacy Score of 85%; with average scores of 21/30 and 71% for those not returning to work. Average length of stay was 4.6(range .5-24) and 7.4(range1.7-18) months for those returning and not returning to work. Other demographic and outcome measures are collected. Conclusions: Despite significant disability, stroke survivors can achieve successful recovery, including return to work and driving. Further study of patients returning to work can help direct rehabilitation efforts for patients with return to work goals.

Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joan C Breen ◽  
Jeanne Andrusin ◽  
Julie DiCarlo ◽  
Julia Keenan ◽  
Paula Fortuna ◽  
...  
Keyword(s):  
Risk Factor ◽  
Return To Work ◽  
Self Efficacy ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Stroke Survivors ◽  
Patient Centered ◽  
Community Based ◽  
Percent Improvement ◽  
Stroke Knowledge

Background: Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals. Methods: Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues. Results: 190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working pre-stroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving pre-stroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected. Conclusions: Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.

Abstract WP152: Characteristics of Stroke Survivors Treated in an Interdisciplinary Outpatient Rehabilitation Program Who Return to Work

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joan Breen ◽  
Jeanne Andrusin ◽  
Tom Ferlito
Keyword(s):  
Return To Work ◽  
Average Length ◽  
Rehabilitation Program ◽  
Stroke Recovery ◽  
Outpatient Rehabilitation ◽  
Stroke Survivors ◽  
Nihss Score ◽  
Rehabilitation Outcomes ◽  
Returning To Work ◽  
Demographic Risk

Background: Return to Employment and driving are goals for many stroke survivors. Little is known about the frequency and characteristics of patients returning to work. Methods: Prospective observational study of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses physical, psychosocial, cognitive, communicative, risk factors, driving, and vocational issues. Results: Of 96 consecutive patients, 48% were working prior to their stroke. 44% (70% men, 30% women) of those working prior to their stroke returned to work upon program completion. On admit, these returning workers had an average age of 56 years, average NIHSS score of 3.4(range 0-9), 40% were aphasic, 65% needed assistance with ADL's(55% with {mRS} of 3 and 10% with {mRS} of 4). 15 of these suffered ischemic strokes( 4 Left, 4 Right, 3 Bi-lateral hemisphere, 4 posterior circulation), and 5 had hemorrhages. All patients working prior to their stroke were also driving, and 15% of these were driving on admit. 90% of those who returned to work also returned to driving. In those returning to work, Stroke Impact Scale(SIS) scores improved an average of: mood 12%, ADL’s 15%, participation 24%, and stroke recovery domain 16%. These patients received an average of 21 physical therapy visits, with 6 minute walk and Berg Balance scores improving an average of 112% and 11% respectively. Multiple other demographic, risk factor, and outcome measures are collected. An additional 9% of patients were work capable on discharge. In comparison, 19 of those not returning to work had ischemic strokes, 7 had hemorrhages. This group had average age 57, average NIHSS score 6.8(range2-16), 42% aphasic, 89% needed assistance with ADL’s (58% with {mRS} of 3 and 31% with {mRS} of 4), and 28% returned to driving. Average length of stay was 4 (range 0.25-12) and 6 months(range 2-12) in those returning and not returning to work respectively. Conclusions: These findings demonstrate that outpatient rehab programs can promote stroke recovery, return to work and driving. Further collection of characteristics and rehabilitation outcomes of patients returning to work can help direct rehabilitation efforts for patients with return to work goals.

Abstract WP195: Patients Beginning Community Based Outpatient Stroke Rehabilitation Program More Than 6 Months Post Stroke Achieve Equally Excellent Outcomes as Sub-Acute Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joan Breen ◽  
Jeanne Andrusin ◽  
Tom Ferlito
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Rehabilitation Program ◽  
Chronic Stroke ◽  
Outpatient Rehabilitation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Community Based ◽  
Post Stroke ◽  
Rehabilitation Programs

Background: Despite the availability of community based outpatient rehabilitation programs in the U.S., few use standardized measure sets and assessments, and outcomes studies are sparse. There is especially a knowledge gap regarding outcomes of participating chronic stroke patients (rehabilitation begins more than 6 months post stroke). Methods: Prospective observational study of stroke patients treated between 12/2011-1/2015 in an interdisciplinary outpatient rehabilitation program that addresses health literacy, risk factors, physical, psychosocial, cognitive, communicative and vocational issues. Patients were classified as chronic if admitted to the program >6 months and sub-acute if admitted <6 months post stroke. Results: Among 96 consecutive patients, 71 were sub-acute (72% ischemic, 28% hemorrhages) and 25 chronic (68% ischemic, 32% hemorrhages) who were admitted to the program an average 18.5 months post stroke (range 6-121 months). Chronic vs subacute stroke patients were 64% vs 59% male, with no difference in age (mean 66, range 27-90 years vs 65, range 18-90 years), but with greater stroke severity (chronic mean NIHSS score 8.32, range 2-15 vs subacute NIHSS of 5.2, range 0-16). On admission, chronic vs subacute patients were 44% vs 34% aphasic and 96% vs 86% needed assistance with activities of daily living (chronic with modified Rankin Scale [mRS] of 3=28% and 4=68% vs subacute mRS of 3=65% and 4=21%). The percent change in outcomes from baseline to program discharge for subacute and chronic stroke patients is presented in the Table. Conclusions: Although age, sex and stroke types were similar in both groups, chronic patients were more severely impaired than subacute patients but achieved greater improvement in activities of daily living, recovery, walking speed, balance, and risk factor knowledge. These findings demonstrate that outpatient rehabilitation programs can aid in stroke recovery independent of time since stroke onset.

scholarly journals Acute Effect of Robotic Therapy (G-EO System™) on the Lower Limb Temperature Distribution of a Patient with Stroke Sequelae

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Fábio Marcon Alfieri ◽  
Caren da Silva Dias ◽  
Artur Cesar Aquino dos Santos ◽  
Linamara Rizzo Battistella
Keyword(s):  
Hemorrhagic Stroke ◽  
Gait Training ◽  
Acute Effect ◽  
Rehabilitation Program ◽  
The Body ◽  
Infrared Sensor ◽  
Stroke Patients ◽  
Robotic Therapy ◽  
Rehabilitation Programs ◽  
Robotic Devices

Robotic therapy has been gaining prominence in poststroke rehabilitation programs. An example of these devices is the G-EO System™, which simulates gait as well as other more complexes standards of gait such as the steps on stairs. However, to the best of our knowledge, there are no studies that apply thermography as a tool to evaluate stroke patients who undertook rehabilitation programs with the aid of robotic devices. The patient IWPS undergoes sequelae of hemorrhagic stroke for 19 months and consequently hemiplegia, had scores of 93 points in the Fugl-Meyer scale, is undertaking a physical rehabilitation program for six months, has no complaints of discomfort due to thermic sensitivity imbalances between the plegic and the contralateral sides, and voluntarily reports that he realizes functionality improvements especially, according to his perception, due to the aid of the robotic therapy in his gait training with the G-EO System™. The thermographic images were captured by an infrared sensor FLIR T650SC. By analyzing the temperature differences between both hemispheres of the body, before, immediately after, and 30 minutes after a robotic therapy for gait training, we observed that the values firstly increased immediately after the training, but after the 30-minute rest an important thermoregulation was achieved.

A Vocational Rehabilitation Index and Return to Work after Compensable Occupational Injuries in Australia

2017 ◽  
Vol 23 (2) ◽  
pp. 69-78 ◽  
Author(s):  
James A. Athanasou
Keyword(s):  
Return To Work ◽  
Vocational Rehabilitation ◽  
Occupational Injury ◽  
Occupational Injuries ◽  
Psychological Problem ◽  
Personal Factors ◽  
Vocational Assessment ◽  
Length Of Treatment ◽  
Returning To Work

This study examined the personal factors as measured by the Vocational Rehabilitation Index and their influence on returning to work after compensable occupational injuries. The participants comprised 462 patients (335 males; 127 females) who underwent a vocational assessment. The length of time since the injury occurred varied from less than 1 year to 15 years with a mean of 3 years (SD = 2). Results indicated that only 23% had returned to work. Just on 30% of the patients had not worked at all since the accident and some 48% had returned to work but were now not working. The major influences on return to work following an occupational injury that were statistically significant (p < 0.001) were (a) the length of treatment (i.e., time since the injury), and (b) whether there was a psychological problem. The findings support the validity of the Vocational Rehabilitation Index for predicting the probability of return to work following an accident.

scholarly journals Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Monica Eftedal ◽  
Torill H. Tveito ◽  
Ulrik Gensby ◽  
M. Kamrul Islam ◽  
Stein Atle Lie ◽  
...  
Keyword(s):  
Sick Leave ◽  
Return To Work ◽  
Mixed Method ◽  
Common Mental Disorders ◽  
Inpatient Rehabilitation ◽  
Occupational Rehabilitation ◽  
Rehabilitation Program ◽  
Interdisciplinary Teams ◽  
Full Time ◽  
Rehabilitation Programs

Abstract Background Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants’ RTW processes. Methods/design We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18–60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. Discussion This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process. Trial registration Current controlled trials ISRCTN12033424, 15.10.2014, retrospectively registered.

Prevalence and predictors of return to work among stroke survivors in Jordan

Work ◽  
2020 ◽  
Vol 67 (4) ◽  
pp. 817-827
Author(s):  
Huda A. Yousef ◽  
Hanan W. Khalil ◽  
Mohammad S. Nazzal ◽  
Khalid I. El-Salem ◽  
Ziad M. Hawamdeh ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Programs ◽  
Rehabilitation Centers ◽  
Occupational Therapy Practice Framework ◽  
Client Factors ◽  
Returning To Work ◽  
Practice Framework ◽  
Low Prevalence

BACKGROUND: Returning to work (RTW) is an essential goal for many stroke survivors. Currently, the prevalence of RTW post stroke in developing countries such as Jordan is unknown. Additionally, more research is required to identify factors that contribute to RTW post stroke. OBJECTIVES: This study aims to (1) determine the prevalence of RTW among stroke survivors in Jordan, and (2) determine the predictors of RTW from a holistic perspective using the Occupational Therapy Practice Framework (OTPF) 3rd edition. METHODS: Recruitment was carried out from different Jordanian hospitals and rehabilitation centers. A complete battery of outcome measures was used to reflect OTPF domains. These included outcome measures of occupations, client factors, performance skills, and context and environment. Logistic regression was used to determine factors that predicted RTW. RESULTS: 69 participants were enrolled; 45 Males, 24 females; mean age±SD, 52.2±11.07 years. Only 29% succeeded in RTW during the first year after stroke onset. The highest percentage of RTW was among craft workers (40% ), and those who were self-employed (60% ). Of those who resumed work, 35% returned to their previous work, while 65% needed to make work modifications, or change positions or jobs. Factors that predicted higher rates of RTW were walking speed (Odds ratio (OR)=0.004, 95% confidence interval (CI)=0.00–0.55, P < 0.02), as well as absence of environmental restrictions (OR = 21.16, 95% CI = 1.91–233.5, P < 0.013). CONCLUSIONS: The alarming low prevalence of RTW among stroke survivors in Jordan emphasizes the essential need to develop vocational rehabilitation programs. Clinicians should pay attention to enhancing walking abilities and reducing environmental restrictions post stroke, in order to improve the occurrence of RTW.

scholarly journals Rehabilitation pathways in women with breast cancer in the first 12 months of the disease: a retrospective study

2020 ◽  
Author(s):  
Chiara Falcicchio ◽  
Domenico Di Lallo ◽  
Alessandra Fabi ◽  
Alessandro Bonucci ◽  
Maria Perrone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Motor Rehabilitation ◽  
Regional Health ◽  
Lazio Region ◽  
Cognitive Interventions ◽  
Rehabilitation Programs ◽  
Rehabilitative Care

Abstract Background: Breast cancer (BC) presents important physical and psychological challenges that should be appropriately addressed through continuous, integrated and individualized rehabilitation programs after treatment. Methods: We retrospectively analyzed data from two archives of the Lazio Regional Health System Database to assess rehabilitation patterns in women diagnosed with BC in the Lazio region (Italy) in 2008.Results: Most patients (81.7%) received outpatient rehabilitative care, consisting mainly of pathology-related interventions and, more rarely, disability-related interventions (mainly motor rehabilitation and rarely cognitive or psychological therapy). Few patients followed an inpatient (1.3%) or an intensive outpatient rehabilitation program (1.0%).Conclusion: Women with BC need more adequate rehabilitation programs, which should focus more on psychosocial and cognitive interventions.

scholarly journals Returning to work after suffering from burnout syndrome: Perceived changes in personality, views, values, and behaviors connected with work

Psihologija ◽  
2014 ◽  
Vol 47 (1) ◽  
pp. 131-147 ◽  
Author(s):  
Eva Bostjancic ◽  
Nika Koracin
Keyword(s):  
Return To Work ◽  
Personal Values ◽  
Maslach Burnout Inventory ◽  
Structured Interview ◽  
Burnout Syndrome ◽  
Work Effectiveness ◽  
Rehabilitation Programs ◽  
Number Of Factors ◽  
Returning To Work

To date only a few studies have focused on returning to work after suffering from burnout syndrome. Participants were asked about their perceived work effectiveness, changes in their personal values, and obstacles and support factors that they encountered when they returned to work. Among the 27 individuals of various professions included in the study, 18 achieved an average or a high score on the Maslach Burnout Inventory, which was used to conduct a semi-structured interview. The answers were later processed by analyzing the content. The results showed that burned-out individuals only slowly return to work after recovery. When they return to work, they encounter changes in personality, personal values, and work effectiveness, and they only receive partial support from the environment. The results draw attention to insufficient detection of the disease by medical staff and employers in Slovenia. Recovering from burnout is a long-term process, which depends most on individuals themselves. At the same time, they can receive the necessary support from their family and coworkers, especially in terms of understanding them and partially adapting their responsibilities at work when they return. This study draws attention to a number of factors that can influence an individual?s process of returning to work and can be used as a basis for developing systematic rehabilitation programs.

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