Customizing Stroke Rehabilitation Using a 'Rehabilitation Problem-Solving Form' for a Home-Based Therapy Model in India
Résumé
Background: Stroke is one of the leading diseases of the ageing world population where about half of the survivors are left with some degree of physical or cognitive impairment. India-centered studies present a higher stroke-rate for younger individuals as compared to high-income nations. With increasing number of younger persons with stroke and an aging population, the social as well as the economic burden of stroke on the health care systems will likely dramatically increase in future. Therefore, innovative home-based methodologies within limited resources are urgently required for stroke rehabilitation in India. Methods: In this pilot study, International Classification of Functioning, Disability and Health (ICF) model was applied for customizing movement therapy for 10 chronic (>6months post-stroke) stroke survivors. The ICF model was implemented with an assessment document called 'Rehabilitation Problem-Solving Form' (RPS-Form). The online RPS-Form was used to monitor patient's response to a short-duration therapy (called Rehab-CYCLE) by assessing all the ICF components. The RPS-Form presented the patients' perspective, and therefore facilitated communications between the patient and his/her multi-disciplinary rehabilitation team consisting of physiotherapists, medical doctors, and rehabilitation engineers. Findings: A 2-weeks-long Rehab-CYCLE of short-duration, moderately-intensive movement therapy in clinic improved activities and participation of 4 out of 10 participants who then consented to continuing the Rehab-CYCLE at their home, while 5 out of 10 participants consented to repeating the Rehab-CYCLE at clinic. Interpretation: Online RPS-Form encouraged the patient to play an active role in customizing his/her therapy - needs, length of intervention, intensity of intervention, functional outcome goals - in cooperation with his/her rehabilitation team. Because of the high therapy costs at rehabilitation clinics in India, a home-based therapy model may be preferable in chronic stroke following a short-duration Rehab-CYCLE at clinic. The home-based Rehab-CYCLE can be monitored with online RPS-Form which needs validation in a clinical study.