Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial

Tom P M M Vluggen; Jolanda C M van Haastregt; Frans E Tan; Jeanine A Verbunt; Caroline M van Heugten; Jos M G A Schols

doi:10.1186/s12877-021-02082-4

Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial

Tom P M M Vluggen^*, Jolanda C M van Haastregt, Frans E Tan, Jeanine A Verbunt, Caroline M van Heugten, Jos M G A Schols

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.

METHODS: A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.

RESULTS: In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (- 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.

CONCLUSION: The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN62286281 . Registered 19-3-2010.

Original language	English
Article number	134
Pages (from-to)	1-11
Number of pages	11
Journal	BMC Geriatrics
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12877-021-02082-4
Publication status	Published - 23 Feb 2021

Keywords

Aftercare
Elderly persons
Geriatric rehabilitation
Randomised controlled trial
Stroke
GLOBAL BURDEN
FUNCTIONAL STATUS
CARE
DISEASE SELF-MANAGEMENT
COMMUNITY
QUALITY-OF-LIFE
PARTICIPATION
CAREGIVERS

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@article{c867bca669d64cacb2633028e640f772,

title = "Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial",

abstract = "BACKGROUND: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.METHODS: A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.RESULTS: In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (- 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.CONCLUSION: The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.TRIAL REGISTRATION: Current Controlled Trials ISRCTN62286281 . Registered 19-3-2010.",

keywords = "Aftercare, Elderly persons, Geriatric rehabilitation, Randomised controlled trial, Stroke, GLOBAL BURDEN, FUNCTIONAL STATUS, CARE, DISEASE SELF-MANAGEMENT, COMMUNITY, QUALITY-OF-LIFE, PARTICIPATION, CAREGIVERS",

author = "Vluggen, {Tom P M M} and {van Haastregt}, {Jolanda C M} and Tan, {Frans E} and Verbunt, {Jeanine A} and {van Heugten}, {Caroline M} and Schols, {Jos M G A}",

note = "Funding Information: This study is funded with a grant (grant number:313070301) from the Netherlands Organisation for Health Research and Development (ZonMw) as part of the National Care for the Elderly Programme, which aims to improve the quality of care for elderly persons by means of developing integrated health care that is adjusted to the individual needs of the elderly persons. The funding organizations had no role in the design, methods, analysis, preparation, or approval of the paper. The views expressed in this publication are those of the authors and not necessarily those of the Netherlands Organization for Health Research and Development (ZonMw). Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = feb,

day = "23",

doi = "10.1186/s12877-021-02082-4",

language = "English",

volume = "21",

pages = "1--11",

journal = "BMC Geriatrics",

issn = "1471-2318",

publisher = "BioMed Central Ltd",

number = "1",

}

Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke: a multicentre randomised controlled trial. / Vluggen, Tom P M M; van Haastregt, Jolanda C M; Tan, Frans E et al.
In: BMC Geriatrics, Vol. 21, No. 1, 134, 23.02.2021, p. 1-11.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Effectiveness of an integrated multidisciplinary geriatric rehabilitation programme for older persons with stroke

T2 - a multicentre randomised controlled trial

AU - Vluggen, Tom P M M

AU - van Haastregt, Jolanda C M

AU - Tan, Frans E

AU - Verbunt, Jeanine A

AU - van Heugten, Caroline M

AU - Schols, Jos M G A

N1 - Funding Information: This study is funded with a grant (grant number:313070301) from the Netherlands Organisation for Health Research and Development (ZonMw) as part of the National Care for the Elderly Programme, which aims to improve the quality of care for elderly persons by means of developing integrated health care that is adjusted to the individual needs of the elderly persons. The funding organizations had no role in the design, methods, analysis, preparation, or approval of the paper. The views expressed in this publication are those of the authors and not necessarily those of the Netherlands Organization for Health Research and Development (ZonMw). Publisher Copyright: © 2021, The Author(s).

PY - 2021/2/23

Y1 - 2021/2/23

N2 - BACKGROUND: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.METHODS: A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.RESULTS: In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (- 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.CONCLUSION: The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.TRIAL REGISTRATION: Current Controlled Trials ISRCTN62286281 . Registered 19-3-2010.

AB - BACKGROUND: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate ambulatory aftercare in the community. Therefore, we developed an integrated multidisciplinary rehabilitation programme that includes aftercare for older persons with stroke. We evaluated the effectiveness of this newly developed rehabilitation programme in comparison to usual care.METHODS: A multicentre randomised controlled trial was conducted in eight geriatric rehabilitation stroke units and their collaborating partners in primary care. The study population involved stroke patients and their informal caregivers who were aged 65 or over, living in the community before admission to geriatric rehabilitation, and expected to be able to return home after discharge. The programme consisted of three modules: inpatient neurorehabilitation, home-based self-management training, and stroke education. For patients, daily activity (FAI) was assessed as primary outcome and functional dependence (Katz-15), perceived quality of life (SSQoL) and social participation (IPA) as secondary outcomes. Additionally, among informal caregivers perceived care burden (self-rated burden VAS), objective care burden (Erasmus iBMG), and quality of life (CarerQol), were assessed as secondary outcomes.RESULTS: In total 190 patients and 172 informal caregivers were included. Mean age of the patients in the intervention group was 78.9 years (SD = 7.0) and in the usual care group 79.0 years (SD = 6.5). Significant favourable effects for the programme were observed for the subscale autonomy outdoors of the IPA (- 2.15, P = .047, and for the informal caregivers perceived care burden (1.23, P = .048. For the primary outcome daily activity and the other secondary outcomes, no significant effects were observed.CONCLUSION: The integrated multidisciplinary programme had no effect on daily activity of older stroke patients. However, patients participating in the programme had a higher level of perceived autonomy of outdoor activities and their informal caregivers perceived a lower care burden. The programme might be promising in providing adequate (after) care, although adaptation of the programme is recommended to increase its feasibility and improve its effects.TRIAL REGISTRATION: Current Controlled Trials ISRCTN62286281 . Registered 19-3-2010.

KW - Aftercare

KW - Elderly persons

KW - Geriatric rehabilitation

KW - Randomised controlled trial

KW - Stroke

KW - GLOBAL BURDEN

KW - FUNCTIONAL STATUS

KW - CARE

KW - DISEASE SELF-MANAGEMENT

KW - COMMUNITY

KW - QUALITY-OF-LIFE

KW - PARTICIPATION

KW - CAREGIVERS

U2 - 10.1186/s12877-021-02082-4

DO - 10.1186/s12877-021-02082-4

M3 - Article

C2 - 33622269

SN - 1471-2318

VL - 21

SP - 1

EP - 11

JO - BMC Geriatrics

JF - BMC Geriatrics

IS - 1

M1 - 134

ER -