IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Eur J Phys Rehabil Med. 2020 Dec;56(6):713-724. doi: 10.23736/S1973-9087.20.06195-X.
To standardize assessment and coordinate processes in stroke rehabilitation, an integrated care pathway (ICP) was developed in an Italian Rehabilitation and Research Institution by a knowledge-translation interdisciplinary process, from evidence-based guidelines to rehabilitation practice. The ICP was implemented in two pilot Tuscan rehabilitation Centers.
The purpose of this study was to describe ICP development and assess the ICP effects on postacute stroke inpatient rehabilitation outcomes.
Prospective observational study, before and after comparison.
Two Tuscan inpatient rehabilitation centers.
Patients accessing either centers for intensive rehabilitation after acute stroke.
Two cohorts were prospectively recruited before (2015-2017) and after (2018) implementation of the pathway. The primary outcome was change in activities of daily living disability, assessed by the modified Barthel Index (mBI) from admission to discharge. Secondary outcomes included length of stay (LOS), adverse outcomes, and changes in communication ability, trunk control, pain, ambulation, bladder catheter (Y/N), bedsores (Y/N).
In 2015-2017, 443 postacute stroke patients (mean age 77±11 years, 47% women), while in 2018, 84 patients (mean age 76±13 years, 61% women) were admitted to the two facilities. Comparing the 2018 vs. the 2015-17 cohort, the mean mBI increase was not substantially different (26 vs. 24 points), nor were LOS (37±18 vs. 36±16 days), adverse outcomes, discharge destination, and improvement of ambulation, pain, and communication (P>0.05). Instead, a significantly higher improvement of trunk control (trunk control test: 69.6±33.2 vs. 79.0±31.3, P=0.019), and a higher percentage of bedsore resolution (13% vs. 5%, P=0.033), and bladder catheter removal (37% vs. 17% P<0.001) were observed in 2018 vs. 2015-2017.
Compared to prior practice, ICP was associated to improvement of trunk control recovery, bladder catheter removal, and bedsores resolution. Further ICP implementation on a larger scale is needed to verify improvements of stroke inpatient rehabilitation outcomes.
An evidence-based stroke rehabilitation ICP was interdisciplinary developed and implemented in two rehabilitation centers of a multicenter Italian health group. ICP implementation as to inpatient intensive postacute stroke rehabilitation was associated to improved trunk control recovery, bladder catheter removal, and bedsore resolution. Further ICP implementation will allow multicenter studies and quality benchmarking.
为了规范脑卒中康复评估并协调流程，一家意大利康复研究机构通过知识转化的跨学科过程，制定了综合护理路径（ICP），将循证指南转化为康复实践。该 ICP 在两个托斯卡纳康复中心进行试点。
本研究旨在描述 ICP 的制定过程，并评估其对急性脑卒中后住院康复结果的影响。
前瞻性观察性研究，前后比较。
两个托斯卡纳住院康复中心。
在急性脑卒中后进入中心接受强化康复治疗的患者。
前瞻性招募了 2015-2017 年（ICP 实施前）和 2018 年（ICP 实施后）进入两个中心的两个队列。主要结局是从入院到出院时日常生活活动能力的变化，用改良 Barthel 指数（mBI）评估。次要结局包括住院时间（LOS）、不良结局、沟通能力、躯干控制、疼痛、步行、膀胱导尿管（是/否）、压疮（是/否）的变化。
2015-2017 年，443 名急性脑卒中后患者（平均年龄 77±11 岁，47%为女性），2018 年，84 名患者（平均年龄 76±13 岁，61%为女性）进入两个设施。与 2018 年相比，2015-2017 年的平均 mBI 增加量没有明显差异（26 分比 24 分），LOS（37±18 天比 36±16 天）、不良结局、出院目的地和步行、疼痛和沟通能力的改善也没有明显差异（P>0.05）。相反，2018 年与 2015-2017 年相比，躯干控制的改善更为显著（躯干控制测试：69.6±33.2 比 79.0±31.3，P=0.019），压疮缓解率更高（13%比 5%，P=0.033），膀胱导尿管去除率更高（37%比 17%，P<0.001）。
与以往的实践相比，ICP 与躯干控制恢复、膀胱导尿管去除和压疮缓解的改善有关。需要在更大范围内进一步实施 ICP，以验证脑卒中住院康复结果的改善。
基于证据的脑卒中康复 ICP 是在一家多中心意大利医疗集团的两个康复中心由跨学科开发和实施的。在急性脑卒中后的住院强化康复中实施 ICP 与躯干控制恢复、膀胱导尿管去除和压疮缓解的改善有关。进一步实施 ICP 将允许进行多中心研究和质量基准测试。
