Studies On The Effects Of Community-based Rehabilitation Therapy On The Function,Economic Analysis And Risk Factors For Stroke Patients

PartⅠ:An analysis about the effects of community-based rehabilitation therapy on activity of daily living for stroke patientsOb0ective:To evaluate the effects of standardized community-based rehabilitation therapy on activity of daily living for stroke patients.Methods: A single-blind,randomized,controlled,multicenter design was used.The communities of rehabilitation and control groups were chosen randomly in every center.Then 737 consecutive stroke patients were stratified by infarction and hemorrhage.The rehabilitation group received an additional standardized community-based rehabilitation therapy.The intervention was applied for 5 months.Patients were evaluated for activity of daily living with Modified Barthel Index before intervention,at the end of 2 and 5 months respectively.Results:The Modified Barthel Index scores between rehabilitation and control group had no significant difference at the time when entry the trial.Patients in the rehabilitation group performed better in the Modified Barthel Index scores than those in the control group after 5 months follow-up(P＜0.01).Although the rehabilitation group and control group both improved over time,but the rehabilitation group showed a greater improvement in the Modified Barthel Index scores when compared with the control group(P＜0.01).After 5 months follow-up,The Modified Barthel Index scores of cerebral infarction rehabilitation group,hemorrhage rehabilitation group and total rehabilitation group improved 26.28,32.89 and 27.72 respectively.In comparison,The Modified Barthel Index scores of cerebral infarction control group,hemorrhage control group and total control group improved 7.65,21.70 and 10.85 respectively.This implies a difference in improvement of 18.63 in cerebral infarction group,11.19 in hemorrhage group,and 16.87 in total group in favor of the rehabilitation group.Conclusion:Standardized community-based rehabilitation therapy during 5 months can help the stroke patients to improve their activity of daily living greatly.PartⅡ:An Analysis about the Effects of Community-based Rehabilitation Therapy on Neurological Function for Stroke PatientsObjective:To evaluate the effects of community-based rehabilitation therapy on neurological function for stroke patients.Methods:A single-blind, randomized,controlled,multicenter design was used.The communities of rehabilitation and control groups were chosen randomly in every center.Then 737 consecutive stroke patients were stratified by infarction and hemorrhage. The rehabilitation group received an additional standardized community-based rehabilitation therapy.The intervention was applied for 5 months.Patients were evaluated for clinical neurological function deficit scores before intervention,at the end of 2 and 5 months respectively.Results:The clinical neurological function deficit scores between rehabilitation and control group had no significant difference at the time when entry the trial.Patients in the rehabilitation group performed better in the clinical neurological function deficit scores than those in the control group after 5 months follow-up(P＜0.01).Although the rehabilitation group and control group both improved over time,but the rehabilitation group showed a greater improvement in the clinical neurological function deficit scores.The differences between groups were significant.After 5 months,The clinical neurological function deficit scores of cerebral infarction rehabilitation group, hemorrhage rehabilitation group and total rehabilitation group improved 6.77,7.99 and 7.03 respectively.In comparison,The clinical neurological function deficit scores of cerebral infarction control group,hemorrhage control group and total control group improved 1.57,5.34 and 2.43 respectively.This implies a difference in improvement of 5.2 in cerebral infarction group,2.65 in hemorrhage group,and 4.6 in total group in favor of the rehabilitation group.Conclusion:Standardized community-based rehabilitation therapy during 5 months can help the stroke patients to improve their neurological function greatly.PartⅢ:An Analysis about the Effects of Community-based Rehabilitation Therapy on Motor Function for Stroke PatientsObjective:To evaluate the effects of community-based rehabilitation therapy on motor function for stroke patients.Methods:A single-blind, randomized,controlled,multicenter design was used.The communities of rehabilitation and control groups were chosen randomly in every center.Then 737 consecutive stroke patients were stratified by infarction and hemorrhage. The rehabilitation group received an additional standardized community-based rehabilitation therapy.The intervention was applied for 5 months.Patients were evaluated for motor function scores before intervention,at the end of 2 and 5 months respectively.Results:The motor function scores between rehabilitation and control group had no significant difference at the time when entry the trial.Patients in the rehabilitation group performed better on the motor function scores than those in the control group after 5 months follow-up(P＜0.01).Although the rehabilitation group and control group both improved over time,but the rehabilitation group showed a greater improvement in the motor function scores.After 5 months,the motor function scores of rehabilitation group improved 17.4.In comparison,The motor function scores of control group improved 7.27.This implies a difference in improvement of 10.13 in total group in favor of the rehabilitation group.Conclusion:Standardized community-based rehabilitation therapy during 5 months can help the stroke patients to improve their motor function greatly.PartⅣ:An Analysis about the Cost-effectiveness of Community-based Secondary Prevention and Rehabilitation Therapy on Improving of Comprehensive Function for Stroke Patients.Objective:To evaluate the cost-effectiveness analysis of community-based secondary prevention and rehabilitation therapy on comprehensive function for stroke patients.Methods:Asingle-blind,randomized,controlled,multicenter design was used.The communities of rehabilitation and control groups were chosen randomly in every center.Then 589 consecutive stroke patients were stratified by infarction and hemorrhage.The rehabilitation group received an additional standardized community-based rehabilitation therapy.The intervention was applied for 5 months.Patients were evaluated for comprehensive function scores before intervention,at the end of 2 and 5 months respectively.Each patient's direct medical costs,direct non-medical costs,indirect costs,follow-up costs of community-based secondary prevention and rehabilitation therapy,costs of community-based secondary prevention and detailed buildups of every cost during the stage of 5 months were collected.Results:The comprehensive function scores between rehabilitation and control group had no significant difference at the time when entry the trial.After 5 months,the comprehensive function scores of rehabilitation group improved 17.25.In comparison,The comprehensive function scores of control group improved 5.21.There was statistical difference between rehabilitation group and control group(P＜0.01).In the rehabilitation group,with every one point improvement of comprehensive function,the inpatient diagnosis and treatment costs,direct medical costs,or total costs should be expended￥108.06,￥605.6,and￥838.42 respectively;In the control group,with every one point improvement of comprehensive function, the inpatient diagnosis and treatment costs,direct medical costs,or total costs should be expended￥306.29,￥1247.00,and￥1601.55 respectively;With every one point's improvement of comprehensive function in the rehab group, all kinds of costs should be used are lower than those of controlled group.The costs of controlled group are about 2 times of those of rehab group.Conclusion:Standardized community-based secondary prevention and rehabilitation therapy during 5 months is an effective and economical program to improve the comprehensive function of stroke patients in the community. PartⅤThe effects of community-based secondary prevention and rehabilitation therapy on risk factors and adverse effect for stroke patients.Objective:To evaluate the effects of community-based secondary prevention and rehabilitation therapy on risk factors and adverse effect for stroke patients.Methods:Asingle-blind,randomized,controlled,multicenter design was used.The communities of rehabilitation and control groups were chosen randomly in every center.Then 589 consecutive stroke patients were stratified by infarction and hemorrhage.The rehabilitation group received an additional standardized community-based rehabilitation therapy.The intervention was applied for 5 months.Blood pressure,triglyceride,total cholesterol,high-density lipoproteins and fasting blood sugar were collected before intervention,at the end of 5 months respectively.We also collected the adverse effects in 5 months.Results:The risk factors between rehabilitation and control group had no significant difference at the time when entry the trial.Although the improvement of blood pressure,triglyceride,total cholesterol, high-density lipoproteins,fasting blood sugar and blood viscosity in rehabilitation group was a little better than thoese of control group,there was no statistical difference between groups.The death proportion of rehab group and control group are 6.60‰and 13.99‰respectively;The recurrence proportion in rehab group and control group are 9.9‰and 10.49‰respectively.Although the improvement of recurrence proportion in rehabilitation group was a little better than thoese of control group,there was no statistical difference between groups.The fracture happened in rehabilitation group was more than those in control group,but there was no statistical difference between groups.Conclusion:After standardized community-based secondary prevention and rehabilitation therapy during 5 months,the improvement of risk factors,death proportion and recurrence proportion in rehabilitation group was a little better than thoese of control group.There was no statistical difference between groups.We still need further research in the future.