Browsing by Subject "Stroke rehabilitation"
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Item Open Access Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A Three-Arm Randomized Controlled Trial.(Archives of physical medicine and rehabilitation, 2021-09-10) Matchar, David Bruce; Young, Sherry Hsueh Yi; Sim, Rita; Yu, Christine Jia Ying; Yan, Xiaoxi; De Silva, Deidre Anne; Chakraborty, BibhasObjective
To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense).Design
Three-arm randomized controlled trial Setting: Stroke units of two Singapore tertiary hospitals Participants: Singaporeans or permanent residents aged ≥21 years who were diagnosed with stroke and discharged home with physician's recommendation to continue outpatient rehabilitation.Interventions
A Transportation Incentives arm (T), which provides free transportation services, a Transportation & Sessions Incentives arm (T&S), offering free transportation and prescribed stroke rehabilitation sessions, and a control arm, Education (E), consisting of a stroke rehabilitation educational programme.Main outcome measures
The primary study outcome was uptake of outpatient rehabilitation services (ORS) amongst post-stroke patients, and key pre-defined secondary outcomes being number of sessions attended and adherence to prescribed sessions.Results
Uptake rate of ORS was 73.0% for E (CI, 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). Differences of T and T&S versus E were not statistically significant (p=0.22 and p=0.10, respectively). However, average number of rehabilitation sessions attended were significantly higher in both intervention arms: 5.50 (SD, 7.65) for T and 7.51 (SD, 9.52) for T&S versus 3.26 (SD, 4.22) for control arm (E) (p-value for T vs E =0.017; p-value for T&S vs E =0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029).Conclusions
This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing stroke survivors to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services.Item Open Access Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis.(Journal of the American Medical Directors Association, 2021-04) Chong, Wayne FW; Ng, Leong Hwee; Ho, Ringo M-H; Koh, Gerald CH; Hoenig, Helen; Matchar, David B; Yap, Philip; Venketasubramanian, Narayanaswamy; Tan, Kelvin B; Ning, Chou; Menon, Edward; Chang, Hui Meng; De Silva, Deidre A; Lee, Kim En; Tan, Boon Yeow; Young, Sherry HY; Ng, Yee Sien; Tu, Tian Ming; Ang, Yan Hoon; Yeo, Tseng Tsai; Merchant, Reshma A; Kong, Keng He; Singh, Rajinder; Ng, Yu Li; Cheong, AngelaObjectives
To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates.Design
Latent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome.Setting
and Participants: A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study.Methods
Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates.Results
Two distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke.Conclusions and implications
Whether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation.