Outcome of home-based physiotherapy between first visit within 30 days and during 30-90 days after stroke onset

Abstract

Introduction After discharging from hospitals, individuals with stroke still need physiotherapy to facilitate the recovery of their physical functions. Home-based physiotherapy is an option in Thailand, and prompts to visit them at home. There are factors influencing on time course to the first visit at home, for example, length of stay in hospital, long queue for the first visit, and etc. The long time interval before the first visit at home may delay physical ability improvement in individuals with stroke since early rehabilitation shows a better recovery than the late1. The most appropriate level of home-based physiotherapy service delivery is suggested to be needed2. Purpose To examine effect of home-based physiotherapy between first visit within 30 days and during 30-90 days after stroke onset. Participants 248 individuals with first stroke (124 first home-based physiotherapy within 30 days after stroke, 124 first home-based physiotherapy during 30-90 days after stroke) caused by cerebral thrombosis or emboli and discharged from hospitals, intended to join in stroke Care in Community Project of Faculty of Physical Therapy, Mahidol University participated in the study. (Table 1). Methods Ethic: Approved by Mahidol University Institutional Review Board. Protocols: For home-based physiotherapy, physiotherapists visited individuals with stroke at home, assessed physical abilities, designed therapeutic exercise, taught the participants and care givers to follow the exercises and activities of daily living (ADL) training programme. The participants were visited for 7 months with the frequency as follows; every week in the first month, every other week in the second, the third, and the fourth months, once a month in the fifth, the sixth, and the seventh months. At every visit, physiotherapists recorded data of physical abilities; consciousness by Glasgow Coma Scale3 (GCS), ADL performances by Barthel Index4 (BI), postural function by Postural Assessment Scale for Stroke Patient5 (PASS), and movement skills by stroke Rehabilitation Assessment of Movement6 (STREAM). Outcome measures: GCS3 is composed of 3 domains; eye, verbal, and motor. The scores are between 3 and 15, which 3 is the worst and 15 is the best. BI4 contains 10 items: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers, mobility, and stairs. Score range is from 0 to 100. The higher score indicates the better ADL function. PASS5 consists of 5 items for postural maintenance and 7 items for postural change, totally 12 items. Score range is from 0 to 36. The higher score indicates the better postural function. STREAM6 contains 30 voluntary movement items: 10 for upper limb, 10 for lower limb, 10 for basic mobility. A total score for each subscale is calculated and is converted to a percentage score out of 100. The higher percentage score indicates the better movement. Analysis: The first and the last scores of GCS, BI, PASS, and STREAM were analysed. Analysis of covariance (ANCOVA) was conducted to compare the last score of physical abilities between groups. If ANCOVA could not be applied, two-way repeated multivariate analysis of variance was used. Significant level was set at p<0.05. Results There was significant (p=0.001) difference in BI, PASS, and STREAM between the first and last visits (Figure 1). Significant (p=0.001) influence on BI, PASS, and STREAM, but not on GCS (p=0.224), was shown between first home-based physiotherapy within 30 days and that during 30-90 days (Figure 2). However, no effect of home-based physiotherapy were observed (p=0.290) within and between groups (Figure 3).