Deans' stroke musings: Patient activation during the first 6 months after the start of stroke rehabilitation

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 21, 2022

Patient activation during the first 6 months after the start of stroke rehabilitation

Are you that blitheringly oblivious to the easy solution to patient motivation? EXACT 100% RECOVERY PROTOCOLS! Your guidelines are worthless, survivors have little incentive to work on them because they have nothing specific in them and no guarantee of results. Yeah, creating them is a BHAG(Big Hairy Audacious Goal. But leaders tackle BHAGS all the time because they are leaders.

But once created your patient will be too busy doing the reps because they know at the end is recovery.

Sietske JTammingaPhD¹² prof. MartaFioccoPhD³⁴ Alessandra GonzalezAvilaMSc¹ GerardVolker¹ Steffi MJJanssenMSc¹ prof. Thea PM VlietVlielandMD, PhD¹² Daniella MOosterveerMD, PhD¹² SCORE-study group

https://doi.org/10.1016/j.apmr.2022.02.017 Get rights and content

Under a Creative Commons license

Open access

Highlights

•: Patient activation increased from start of stroke rehabilitation up to 6 months
•: At all time points a third of patients were in low levels of activation (1 or 2)
•: Over time 41.6% of stroke patients remained in the same level of patient activation
•: 23.1% of stroke patients decreased in level of patient activation over time

Abstract

Objective

– To examine patient activation from the start of stroke rehabilitation and its course up until the 6 month follow-up.

Design

– Inception cohort study with a follow-up of 6 months.

Setting

– Multidisciplinary rehabilitation facility.

Participants

– 478 stroke patients who received inpatient or outpatient rehabilitation with a median age of 63.0 years (inter quartile range (IQR) 56.0-70.0 years) with 308 (64.2%) being male. The study was completed by 439 (91.8%) patients.

Interventions

– Not applicable.

Main Outcome Measures

– Patient activation was measured with the Patient Activation Measure (PAM, score 0-100, 4 levels, where a higher score and level denotes more patient activation). The PAM was measured at the start of the rehabilitation (baseline), and 3 and 6 months thereafter, and analysed using the multivariate mixed model analysis.

Results

– At baseline, the mean PAM score was 60.2 (SD 14.3), with the number of patients in PAM level 1, 2, 3 and 4 being 76 (17.8%), 85 (19.9%), 177 (41.4%) and 90 (21.0%), respectively. The multivariate mixed-model analysis demonstrated that the PAM score increased over time (baseline 60.2 (Standard Deviation (SD) 14.3) versus 3 months 60.7 (SD 14.8) versus 6 months 61.9 (SD 18.0), p 0.007). Between baseline and 6 months, 122 (41.4%) patients remained at the same PAM level, 105 (35.6%) patients increased, and 68 (23.1%) decreased. At all time points, >35% of patients were in level 1 or 2.

Conclusion

– PAM scores increased slightly over time from the start of rehabilitation up to the 6 month follow-up. However, more than a third of patients remained at low levels (i.e. level 1 and 2) of patient activation, which indicates that specific interventions during rehabilitation to increase patient activation might be of value.