RESUMO
BACKGROUND: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice. METHODS: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-CompassTM was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross-sectionalstudy with 48 patients at 5-month follow-ups after subarachnoid hemorrhage. RESULTS: The Rehab-CompassTM identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-CompassTM appeared to be feasible and time-efficientin clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-CompassTM graph. In the studied stroke patients, the Rehab-CompassTM identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems. CONCLUSIONS: The graphic Rehab-CompassTM seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-CompassTM more concise and evaluate the instrument among different stroke subgroups.
Assuntos
Técnicas de Apoio para a Decisão , Necessidades e Demandas de Serviços de Saúde , Avaliação das Necessidades , Medidas de Resultados Relatados pelo Paciente , Avaliação de Processos em Cuidados de Saúde , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Atividades Cotidianas , Idoso , Lista de Checagem , Tomada de Decisão Clínica , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Recuperação de Função Fisiológica , Participação Social , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Resultado do TratamentoRESUMO
UNLABELLED: Modern stroke rehabilitation should be conducted on a step by step approach towards final achievable objectives. Guidelines about how to introduce this in daily work are however missing. The aim of the present study was to create and introduce a paradigm with intermediate and final objectives in a multidisciplinary stroke team. METHOD: Over a period of eight months the staff was trained to use team conferences to evaluate and formulate intermediate and final objectives. The staff s ability to formulate correct objectives and their knowledge about previously agreed targets were evaluated monthly through a questionnaire. RESULTS: The number of objectives that were accurately formulated improved from 50% to 90% and the caring team' s awareness of these improved from 45% to >80g. CONCLUSIONS: This model can be used to improve the multidisciplinary caring team's ability to formulate objectives and keep current objectives in mind in the daily work in a stroke unit.
