ABSTRACT
OBJECTIVE: To assess the structure and process of stroke rehabilitation in Nebraska hospitals. DESIGN: Cross-sectional mail survey using the Dillman tailored-design method of administration. SETTING: Hospitals in Nebraska. PARTICIPANTS: Approximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are critical access hospitals (CAHs) that are limited to 25 beds. Our study sample of hospitals (N=53) included the 19 hospitals licensed for 47 to 689 beds (non-CAHs) and a stratified random sample of 34 of the 65 CAHs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported stroke rehabilitation team structure and processes, purposes of and barriers to the use of evidence-based standardized assessments, specific assessments used, and access to specialized stroke rehabilitation services and community resources. RESULTS: Thirty-six (68%) of the 53 hospitals responded to the survey. Approximately 61% of the hospitals used an organized team to provide stroke rehabilitation; 8% of the hospitals-all non-CAHs-had a team dedicated to stroke rehabilitation. After adjusting for hospital size, having an organized team was significantly associated with the use of standardized assessments to improve communication, measure progress and outcomes, evaluate effectiveness of practice, and compare patient outcomes across conditions. Access to specialized stroke rehabilitation professionals and services was significantly greater in non-CAHs. CONCLUSIONS: Hospital size and the presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals. Further research is needed to determine (1) whether team structure is a determinant of stroke rehabilitation outcomes across the continuum of care settings, (2) the needs of rural stroke survivors, and (3) whether technology can facilitate the use of stroke rehabilitation standardized assessments by rural health care professionals.
Subject(s)
Patient Care Team/organization & administration , Physical Therapy Department, Hospital/organization & administration , Physical Therapy Modalities/organization & administration , Stroke Rehabilitation , Communication , Cross-Sectional Studies , Evidence-Based Medicine , Health Services Accessibility/organization & administration , Humans , Nebraska , Outcome Assessment, Health Care , Patient Care Team/standards , Physical Therapy Department, Hospital/standards , Physical Therapy Modalities/standards , Stroke/epidemiologyABSTRACT
BACKGROUND AND PURPOSE: Balance impairments are common in persons with multiple sclerosis (MS), but clinical balance tests may not detect subtle deficits in adults with MS who are not yet experiencing functional limitations or disability. The purpose of this study was to determine if center of pressure (COP) displacement during standing tasks could be a useful performance-based evaluative measure for adults with MS who have minimal or no balance deficits on clinical examination using the Berg Balance Scale (BBS). SUBJECTS AND METHODS: Twenty-one adults with MS were compared with 21 age- and gendermatched healthy adults. Subjects with MS were tested with the BBS, Mini-mental State Exam, Expanded Disability Status Scale (EDSS), and Multiple Sclerosis Functional Composite (MSFC). They also performed voluntary leaning and reaching movements while kinematic and kinetic data were collected. Control subjects performed the same tasks with the exception of the EDSS and MSFC. RESULTS: COP displacement during reaching and leaning was less in adults with MS when compared to control subjects. There were no differences in anthropometric, kinematic, or foot position variables that could account for this difference. Furthermore, there was no difference between groups when COP displacement during reaching was expressed as a percentage of the maximum COP displacement during leaning. DISCUSSION AND CONCLUSION: COP measures show clear differences when comparing healthy adults with minimally impaired adults with MS. The lack of between-group differences when COP displacement during reaching was expressed as a percentage of the maximum COP displacement during leaning suggests that the subjects with MS adopt a reaching strategy that allows them to stay within their reduced limits of stability. COP measures during standing tasks appear well-suited to quantifying changes in postural control over time or in response to intervention for minimally impaired persons with MS.
