Effectiveness of intensive rehabilitation treatment in hemiplegic patients after a stroke
DOI:
https://doi.org/10.28957/rcmfr.v31n2a2Keywords:
Cerebrovascular Accident, Rehabilitation, High-Intensity Interval TrainingAbstract
Introduction. Cerebrovascular accidents (CVA), or strokes, are considered the second cause of death and the third cause of disability worldwide. In Ecuador, they constitute the leading cause of mortality and are a threat to health due to the degree of disability they can cause, which generates a great socioeconomic impact, as well as on the family and on the quality of life of the population that suffers from these disorders.
Objective. To determine the effectiveness of intensive and non-intensive rehabilitation treatment in hemiplegic patients after a CVA treated in the physical medicine and rehabilitation service of a hospital in Guayaquil, Ecuador, between 2015 and 2018.
Materials and methods. Non-experimental cross-sectional study conducted in 99 outpatients with a diagnosis of CVA. The Barthel index was applied, correlating the response to intensive and non-intensive rehabilitation treatment in the period of time already defined to establish the improvement in the quality of life of the patients.
Results. The diagnosis of CVA was more prevalent in males (67.7%), in addition it was found that 67.7% of the cases were of ischemic type and that there were complications in 17.2%, and comorbidities in 73.7%. A statistically significant association (p = 0.010) with the degree of disability and the quality of life was established when the rehabilitation treatment was initiated early. A Chi square of 62.878 and an alpha value of 0.0001 indicated a statistical association between intensive rehabilitation and favorable outcomes according to the Barthel index.
Conclusions. High-intensity treatment produces better functional recovery in hemiplegic patients after a CVA.
References
World Health Organization (WHO). The atlas of Heart Disease and Stroke. Ginebra: WHO; 2004 [citado enero 7 de 2018]. Disponible en: https://apps.who.int/iris/handle/10665/43007.
Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA, et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015;45(3):190-202. Disponible en: https://doi.org/10.1159/000441098.
Moreno-Zambrano D, Santamaria D, Ludena C, Barco A, Vásquez D, Santibáñez-Vásquez R. Enfermedad Cerebrovascular en el Ecuador: Análisis de los Últimos 25 años de Mortalidad, Realidad Actual y Recomendaciones. Rev Ecuat Neurol. 2016;25(1-3):17-20.
Greenberg E, Treger J, Ring H. Post-Stroke Follow-Up in a Rehabilitation Center Outpatient Clinic. Isr Med Assoc J. 2004;6(10):603-6.
Utida KAM, Batiston AP, Souza LA. Level of functional independence of patients after stroke assisted by a multidisciplinary team in a rehabilitation unit. Acta Fisiátr. 2016;23(3):107-12. Disponible en: https://doi.org/10.5935/0104-7795.20160021.
Kamalakannan S, Gudlavalleti-Venkata M, Prost A, Natarajan S, Pant H, Chitalurri N, et al. Rehabilitation Needs of Stroke Survivors After Discharge from Hospital in India. Arch Phys Med Rehabil. 2016;97(9):1526-32.e9. Disponible en: https://doi.org/10.1016/j.apmr.2016.02.008.
Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability Measures in Stroke: Relationship Among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke. 2004;35(4):918-23. Disponible en: https://doi.org/10.1161/01.STR.0000119385.56094.32.
Saxena S, Ng T, Yong D, Koh G. Functional outcomes in inpatient rehabilitative care of stroke patients: predictive factors and the effect of therapy intensity. Quality in Primary Care. 2006;14:145-53.
Kinoshita S, Momosaki R, Kakuda W, Okamoto T, Abo M. Association Between 7 Days Per Week Rehabilitation and Functional Recovery of Patients with Acute Stroke: A Retrospective Cohort Study Based on the Japan Rehabilitation Database. Arch Phys Med Rehabil. 2017;98(4):701-6. Disponible en: https://doi.org/10.1016/j.apmr.2016.11.004.
Aziz NA, Leonardi-Bee J, Phillips M, Gladman JR, Legg L, Walker MF. Therapy-based rehabilitation services for patients living at home more than one year after stroke. Cochrane Database Syst Rev. 2008;2008(2):CD005952. Disponible en: https://doi.org/10.1002/14651858.CD005952.pub2.
Rozo AL, Jiménez-Juliao A. Medida de la independencia funcional con escala FIM en los pacien- tes con evento cerebro vascular del Hospital Militar Central de Bogotá en el periodo octubre 2010 – mayo 2011. Revista Med. 2013;21(2):43-52.
Musicco M, Emberti L, Nappi G, Caltagirone C. Early and long-term outcome of rehabilitation in stroke patients: The role of patient characteristics, time of initiation, and duration of interventions. Arch Phys Med Rehabil. 2003;84(4):551-8. Disponible en: https://doi.org/10.1053/apmr.2003.50084.
Lohse KR, Lang CE, Boyd LA. Is Better? Using Metadata to Explore Dose-Response Relationships in Stroke Rehabilitation. Stroke. 2014;45(7):2053-8. Disponible en: https://doi.org/10.1161/STROKEAHA.114.004695.
Khan F, Amatya B, Galea MP, Gonzenbach R, Kesselring J. Neurorehabilitation: applied neuroplasticity. J Neurol. 2016;264(3):603-15. Disponible en: https://doi.org/10.1007/s00415-016-8307-9.
Bernhardt J, Churilov L, Ellery F, Collier J, Chamberlain J, Langhorne P, et al. Prespecified dose- response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology. 2016;86(23):2138-45. Disponible en: https://doi.org/10.1212/WNL.0000000000002459.
Barrero SCL, García AS, Ojeda MA. Índice de Barthel (IB): Un instrumento esencial para la evaluación funcional y la rehabilitación. Plasticidad y Restauración Neurológica. 2005;4(1-2):81-85.
Ohura T, Hase K, Nakajima Y, Nakayama T. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients. BMC Med Res Methodol. 2017;17(1):131. Disponible en: https://doi.org/10.1186/s12874-017-0409-2.
Giannotti E, Merlo A, Zerbinati P, Longhi M, Prati P, Masiero S, et al. Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters. Eur J Phys Rehabil Med. 2016;52(3):296-303.
Pan XL. Efficacy of early rehabilitation therapy on movement ability of hemiplegic lower extremity in patients with acute cerebrovascular accident. Medicine (Baltimore). 2018;97(2):e9544. Disponible en: https://doi.org/10.1097/MD.0000000000009544.
Eicher V, Murphy MO, Murphy TF, Malec JF. Progress Assessed with the Mayo-Portland Adaptability Inventory in 604 Participants in 4 Types of Post–Inpatient Rehabilitation Brain Injury Programs. Arch Phys Med Rehabil. 2012;93(1):100-7. Disponible en: https://doi.org/10.1016/j.apmr.2011.06.038.
Sehatzadeh S. Effect of Increased Intensity of Physiotherapy on Patient Outcomes After Stroke: An Evidence-Based Analysis. Ont Health Technol Asses Ser. 2015;16(6):1-42.
Königs M, Beurskens EA, Snoep L, Scherder EJ, Oosterlaan J. Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. Disponible en: https://doi.org/10.1016/j.apmr.2018.01.013.
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