[A Systematic Review] The Clinical, Quality of Life and Economic Outcomes of Inpatient Rehabilitation – Full Text PDF

Abstract

Objective: To systematically review the clinical, functional and economic benefits of Inpatient Rehabilitation for the most common disorders of the nervous system: stroke, spinal cord injury, and multiple sclerosis.

Methodology: PubMed, Embase, Scopus, CEA Registry, and NHS EED databases were searched using combinations of three sets of keywords using various terms for rehabilitation, benefits, and treatments. The outcomes considered included measures of independence in activities of daily living (ADL), motor function, disability, handicap,
gait velocity, quality of life, and economics. Following the initial literature search, the abstracts and full texts of the identified studies were reviewed and assessed for inclusion by two independent researchers based on pre-determined criteria. The data of selected studies were extracted into a data extraction form and consequently were synthesized.

Results: Forty-six articles met the inclusion criteria. Particularly, 21 studies evaluated inpatient rehabilitation after (or following) stroke, 15 studies evaluated inpatient rehabilitation after SCI, and seven studies evaluated inpatient rehabilitation for MS patients. The remaining three studies referred to mixed patient population. The majority of studies indicated that inpatient rehabilitation can provide clinical and functional benefits for all patient groups under consideration. Moreover, economic evaluations indicate that rehabilitation may be cost saving or cost-effective in certain patient groups such as those with fractures and stroke.

Conclusion: The results of the present review demonstrate that inpatient rehabilitation may deliver significant health and economic benefits for patients suffering from stroke, spinal cord injury, or multiple sclerosis and for health systems. Further research is needed to improve the consistency and robustness of the available evidence.

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[Abstract] Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient’s home

Abstract

Background

Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the internet, can contribute to ensuring that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance.

Methods/design

A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups.

Discussion

Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services.

Source: Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient’s home

[Abstract] Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient’s home

Abstract

Background

Telerehabilitation (TR), or the provision of rehabilitation services from a distance using telecommunication tools such as the internet, can contribute to ensuring that patients receive the best care at the right time. This study aims to assess the effect of an interactive virtual reality (VR) system that allows ongoing rehabilitation of the upper extremity (UE) following a stroke, while the person is in their own home, with offline monitoring and feedback from a therapist at a distance.

Methods/design

A single-blind (evaluator is blind to group assignment) two-arm randomized controlled trial is proposed, with participants who have had a stroke and are no longer receiving rehabilitation services randomly allocated to: (1) 4-week written home exercise program, i.e. usual care discharge home program or (2) a 4-week home-based TR exercise program using VR in addition to usual care i.e. treatment group. Motor recovery of the UE will be assessed using the Fugl-Meyer Assessment-UE and the Box and Block tests. To determine the efficacy of the system in terms of functional recovery, the Motor Activity Log, a self-reported measure of UE use will be used. Impact on quality of life will be determined using the Stroke Impact Scale-16. Lastly, a preliminary cost-effectiveness analysis will be conducted using costs and outcomes for all groups.

Discussion

Findings will contribute to evidence regarding the use of TR and VR to provide stroke rehabilitation services from a distance. This approach can enhance continuity of care once patients are discharged from rehabilitation, in order to maximize their recovery beyond the current available services.

Source: http://www.contemporaryclinicaltrials.com/article/S1551-7144(15)30136-1/abstract