A Randomized Controlled Trial Of Early Rehabilitation Clinical Pathway After Ischemic Stroke

Objective:To investigate the effect of rehabilitation clinical pathway combined rehabilitation program for patients with ischemic stroke and to provide theoretical basis for optimization and extension of early rehabilitation clinical pathway of stroke.Method:This is a randomized, sham-controlled, assessor blinded, multi-centre prospective study. A total of 286 patients with ischemic stroke were randomized into the clinical pathway group and the conventional rehabilitation group. Patients in the clinical pathway group were treated according to specific rehabilitation clinical pathway, while the conventional rehabilitation group received usual rehabilitation program. The outcome measures included the Modified Barthel Index (MBI), the brief ICF Core Set for stroke, the Fugl-Meyer Motor Assessment Scale (FMA) and the Gugging Swallowing Screen (GUSS) were performed separately before and after clinical pathway intervention.Results:Two hundred fifty-six subjects which contained the clinical pathway group (N=136, Male=90, Female=46) and the conventional rehabilitation group (N=123, Male=91, Female=32) were entered into final statistical analysis. Firstly, The difference of MBI and the brief ICF Core Set for stroke, the improved scores of MBI in the clinical pathway group were higher than those of the conventional rehabilitation group (P<0.05), while no significant difference in FMA difference and FMA improved scores (P>0.05) were observed. Secondly, Seventy-one stroke patients with dysphagia were screened. The GUSS demonstrated a significant improvement after clinical pathway intervention (N=39), compared to the conventional rehabilitation group (N=32). Finally, The cost-effectiveness analysis found that activities of daily living MBI scores were improved 1 point, the in-hospital costs (889.92 Yuan RMB) and the rehabilitation costs (344.72 Yuan RMB) of clinical pathway group were lower than those of the conventional rehabilitation group (1161.22 and 685.68 Yuan RMB). The incremental cost-effectiveness analysis indicated that MBI were improved extra 1 point, the extra in-hospital costs and the rehabilitation costs were 196.73 and 95.50 Yuan RMB respectively. The sensitivity analysis also supported the results that the cost-effectiveness ratio of clinical pathway was lower.Conclusion:Early rehabilitation clinical pathway, which combined with standardized rehabilitation program, can improve activities of daily living, main function and swallowing function of ischemic stroke patients, and spared the costs of in-hospital and rehabilitation.