Effects of the Clinical Pathway in Acute Phase Rehabilitation on Walking Ability Recovery in Elderly Stroke Patients / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

To determine whether the clinical pathway in acute phase rehabilitation contributes to the early recovery of walking ability in elderly stroke patients, we developed a pathway for acute stroke patients over 65 years old who had lower extremity paresis. The pathway goal was to have patients walking within four weeks after the start of physiotherapy. We compared the improvement in walking ability during their stay in the stroke unit, length of stay and discharge destination between the two groups, namely the pre-pathway group that comprised 41 patients admitted before the introduction of the pathway and the post-pathway group that comprised 54 patients admitted after its introduction. In the post-pathway group, 68.5% of the patients achieved the goal, and the days required to achieve the goal were 9.6±6.0 days after the start of physiotherapy. The proportion of patients whose walking ability improved was significantly higher in the post-pathway group than the pre-pathway group (66.7% versus 39.0%, <i>p</i>=0.007). The efficiency of improvement was also higher in the post-pathway group (<i>p</i>=0.024). Logistic regression analysis showed that the use of the pathway was a factor that independently contributed to the improvement of walking ability (odds ratio, 2.80 ; 95% CI, 1.04 to 7.56 ; <i>p</i>=0.042). No significant differences were noted between the two groups in length of stay or discharge destination. From these results, it is suggested that the clinical pathway in acute phase rehabilitation promotes the recovery of walking ability in elderly stroke patients.