PROSPECTIVE EVALUATION OF POST STROKE REHABILITATION IN FLORENCE, ITALY

Most stroke patients and caregivers perceived rehabilitation as effective,(If they didn't get 100% recovered it was not effective. You are trying to justify failure by using the tyranny of low expectations.) 

PROSPECTIVE EVALUATION OF POST STROKE REHABILITATION IN FLORENCE, ITALY

 M BALDERESCHI1, C BIRICOLTI2, B PICCARDI3, F GERLI4, M ZORN4,  B BERTACCINI4, A DI CARLO1, A VIVIANI4, D INZITARI5  1CNR, INSTITUTE OF NEUROSCIENCE, Florence, Italy; 2ASL TOSCANA CENTRO, Florence, Italy; 3AOU Careggi, Florence, Italy; 4Dept. of Statistics, University of Florence, Florence, Italy; 5Dept. of NEUROFARBA, University of Florence, Italy. Introduction Recovery and return to a full and meaningful life following stroke are the main goals for stroke survivors, their families and health professionals. Stroke rehabilitation requires coordination and integration of in- and out-patient health services to be effective. This survey aimed at auditing access, quality and effectiveness of the transition from intensive (in-hospital) to community (outpatient) rehabilitation of all the adult stroke survivors in the Florence area. Information about rehabilitation trajectories was gathered from stroke patient-caregiver dyadic perspective.
References •van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19: 604-607. •Walker M, Hoffman T, Brady M et al. Improving the development, monitoring and reporting of stroke rehabilitation research: consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabilitation and Neural Repair 2017;31:877-884. •Allen D, Rixson L. How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strenght of the evidence to support their effectiveness in the respect? Int J Evid Based Healthc 2008;6:78-110.
50°CONGRESSO NAZIONALE 12 - 15 OTTOBRE 2019 – BOLOGNA
Methods 
All adult (18 years of age and over) acute stroke patients discharged from all the three in-patient rehabilitation facilities of the Florence area (Figure 1) from October 1, 2016 to September 30, 2017 were enrolled in the study. A standardized telephone questionnaire was prepaired and then administered by two trained physiotherapists at 6 and 12 months after discharge from each in-patient rehab facility. Questionnaire was designed to estimate self-perceived rehab accessibility, duration and effectiveness. Moreover, functional outcomes were estimated by the means of modified Rankin Scale. The study protocol was approved by the Institutional Review Board of the Tuscany Regional Health System. Informed consent was obtained from each subject before enrollment. Results After excluding patients who died or received palliative care, 120 stroke patients were enrolled in the study (Figure 2). Their median age was 74 years (IQR, 64-83 years) and 51,7% were men. Out of the 80 (67%) stroke patients who were prescribed with continuing rehabilitation, the 31,3% could not take advantage of public rehab services, mainly for logistic reasons. Public rehab services were available but time schedule and transportation issues precluded their utilization. The 36% of stroke patients contacted and used private rehab services. Most stroke patients and caregivers perceived rehabilitation as effective,(If they didn't get 100% recovered it was not effective. You are trying to justify failure by using the tyranny of low expectations.) but did complain a too short duration (Table 1 and Table 2). All the 45 patients (56,3%) who managed to continue rehab beyond the first 6 months acknowledged further effectiveness (Table 3), and the Modified Rankin Scale score was <3 in 36% of those patients. Conclusions 
Our study could monitor, in the real world, the sequential transition from in-patient to out-patient post-stroke rehabilitation, that is commonly reported as a bottleneck in the entire stroke care pathway. Our data suggest that logistic improvements are needed to make public out-patient rehab really accessible, and highlight the unmet needs of extending rehabilitation duration beyond the current availability (two 1month rounds). This study also serves as an exploratory research to develop and model effective post-stroke rehabilitation interventions in Italy.