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Contact:

Prof. Dr. phil. habil. Johann Behrens,
Dipl.-Pflege- u. Gesundheitswiss. Christiane Becker 

Martin-Luther-Universität Halle-Wittenberg

Institut für Gesundheits- und Pflegewissenschaft

Magdeburger Str. 8

06097 Halle/Saale

Tel: 0049 (0)3 45 – 557 4472

Fax: 0049 (0)3 45 - 5 57 54 31

E-Mail: christiane.becker@medizin.uni-halle.de

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Participatory rehabilitation process management “Stroke in Saxony-Anhalt” (PaReSiS)

Becker, C. (1), Behrens, J. (1), Kuß, O. (3), Lorenz, S. (1),Müller, T. (2), Richter, D. (2),

Saal, S. (1), Stang A. (4), Schubert, M. (1), Zierz, S. (2)

(1)    Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg

(2)    Universitätsklinik und Poliklinik für Neurologie, Universitätsklinikum Halle

(3)    Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg

(4)    Institut für Klinische Epidemiologie, Martin-Luther-Universität Halle-Wittenberg

 

The project participatory rehabilitation process management “Stroke in Saxony-Anhalt“ (PaReSiS) conducts a case management in a randomised, controlled study, which measures the course of illness and care across different carriers and continues and guides the rehabilitation process beyond the follow-up rehabilitation together with the patients for one year. The main dependent variable of the scientific monitoring is the physical functional ability, measured with the Stroke Impact Scale 3.0. As secondary dependent variables, depression, mortality, reinfarction and quality of life are measured. These data are primarily gathered in an oral standardised survey of patients at three measurement time points: 3 days before discharge from the acute clinic (T0), up to 4 weeks after discharge from hospital or rehabilitation (T1) and one year thereafter (T2).

 

Current status of the project and first results

The recruitment of the study participants and the first survey (t0) was concluded in October 2010 in the study centres. The second survey in the participants’ homes (t1) was completed at the beginning of  2011. 323 persons agreed to participate in the study. 208 patients were recruited from the University Hospital Halle and 115 from the Klinikum Martha-Maria in Halle-Dölau. The randomisation procedure after t1 allocated 131 participants to the intervention group and 135 participants to the control group. In total, 78 dropouts were counted:

 

  1. drop-outs after t0: 57, of whom 6 were deceased, 17 could not be reached, 18 poor general state, 16 no longer interested
  2. current drop-outs after t1; 21, 14 of whom are deceased.

 

In a consideration of the starting sample with 513 potential participants, it was asked how representative randomised controlled studies with patients following a stroke are. The participants of the study clearly differed from the general population of all potential participants in all measured characteristics (screening in the acute clinic). Accordingly, women and older-aged participants are under-represented in the study sample. Equally, an influence of the severity of illness on willingness to participate could be discerned. Our results confirm the influence of age, sex and degree of severity on the willingness to participate in studies for the group of persons considered here (Peterson et al. 2004).

The analysis of the survey data at the time point of the hospital stay (t0) indicates, with 80% of the participants showing an NIHSS value ≤ 5, a group of patients with predominantly slight impairments. An explanatory approach for this phenomenon is provided by non-responder analysis. According to this, of all potential participants, the more severely affected and older patients were less willing to participate in the study.

In the future, it should be examined whether, and to what extent, stroke patients with differing degrees of severity of physical impairment can benefit from the intervention examined here.

The study is registered at ClinicalTrials.gov (Identifier -NCT00687869):http://clinicaltrials.gov/ct2/show/NCT00687869 .

 

Participating Institutions:

 

Project description

Background

Previous findings on the perspective of patients and rehabilitees following a stroke show that in particular, the phase after the follow-up rehabilitation and the possible return to everyday life are marked by a very inconsistent picture. While in some cases, consecutive therapies do not take place despite a continuing impairment, other rehabilitees are successfully able to receive a continuous therapeutic care and professional services to participate in working life and to use this for their rehabilitation (cf. Zimmermann et al. 2006; Schaepe et al. 2009). However, they unanimously report clear difficulties in the run-up to being granted health services.

 

Aims

The study aims to establish whether, and to what extent, in persons affected by stroke and their family members, a successful progression of the rehabilitation process following a stroke can be driven by an individual care management. This should be oriented to the individual patient’s needs outside of the institutional care structures of the acute clinic and inpatient and outpatient rehabilitation measures.

 

Methods

The project is conducted as a randomised, controlled study. The rehabilitation assessment, a structured, oral survey instrument, uses the Stroke Impact Scale 3.0 (SIS 3.0) to measure the main dependent variable of physical functional ability. Moreover, the participants’ quality of life, cognitive functions, living environment, informal help and utilisation of health services are measured. To ensure the validity of the applied instruments including the intervention, a qualitative in-depth interview is additionally carried out in a sample drawn both from the intervention group and the control group. Patients in the intervention group are given, in the framework of a comprehensive rehabilitation process management, the possibility to select from the offer of an internet platform and a telephone-based aftercare, from individual consultations and information events, to take up the offer of home visits based on their own needs, and to find information and support in the ongoing rehabilitation process.

 

Literature

 

Links to the project:

http://www.medizin.uni-halle.de

www.paresis.uni-halle.de




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