Stroke Rehabilitation Clinical Trial
Official title:
The Way to Goal-oriented Therapy Planning in Neurorehabilitation: Adherence to Targeted Clinical Pathways in Subacute Stroke- a Feasibility Study
The aim of this feasibility study is to investigate whether target-oriented treatment planning can be maintained in the rehabilitation of stroke patients using the existing classification (LIMOS) and evidence-based specialist treatment pathways. If the goal-oriented treatment planning cannot be adhered to, reasons for failure should be investigated.
According to Feigin and employees, in 2013 there were 25.7 million people worldwide who
survived a stroke. In order to regain independence in everyday life after a mild to severe
stroke, a rehabilitation phase is recommended. Rehabilitation is a holistic process with the
aim of maximising participation in the daily life of the affected person. Tailor-made
interventions with a focus on impairment, activity and participation should be carried out
for this purpose. The International Classification of Functioning, Disability and Health
(ICF) was developed in a worldwide consensus and declared by the WHO as a generally accepted
framework for describing function and health. In rehabilitation, it is considered as standard
and is used to speak a uniform language between the disciplines, to understand the needs of
patients, to adapt the corresponding interventions to the needs and to measure outcomes. In
order to optimally plan the process, Stroke Guidelines recommend to define goals together
with the patient and to use standardized and valid assessments. So far, the following
assessments have been used for the neurorehabilitation of stroke patients: Barthel Index,
Functional Independence Measure and Functional Assessment Measure as well as the Modified
Ranking Scale, but according to Ottiger and her colleagues there was a lack of
multidisciplinary assessments with good psychometric properties and which are based on ICF.
For this reason, the ICF-based multidisciplinary observation scale (LIMOS) was developed in
Lucerne. It consists of four multidisciplinary components based on the following ICF domains:
motor function, cognition, communication and coping with everyday life. Due to its good
psychometric properties, LIMOS was recommended as a multidisciplinary assessment for
neurorehabilitation. The Rehabilitation Clinic Zihlschlacht (RZS) has an interprofessional
team. Each discipline carries out subject-specific assessments and plans the necessary
therapy units based on empirical values. So far, however, there has been no algorithm that
records the deficits of a stroke patient on an interdisciplinary basis and uses the results
to determine the main therapeutic areas. In RZS, patient satisfaction with the therapy plan
in 2017 was 77%. The reasons for dissatisfaction were: Lack of inclusion of needs, lack of
adaptation to changing needs, time aspects, lack of information and the proportion of
cognitive and motor therapies. Now the therapy planning system is to be optimized. The LIMOS
classification should help to record the patient in an interdisciplinary manner and to
visualize focal points. Together with the patient, goals are discussed which are weighted on
the basis of LIMOS. These results, together with evidence-based subject-specific treatment
pathways, are integrated into an algorithm (GOAL) that creates a goal-oriented treatment
plan.
The aim of this feasibility study is to investigate whether target-oriented treatment
planning can be maintained in the rehabilitation of stroke patients using the existing
classification and evidence-based specialist treatment pathways. If the goal-oriented
treatment planning cannot be adhered to, reasons for failure should be investigated.
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