| Background:Around the world, over two-thirds of stroke deaths are in developing countries. As the largest developing country, China has a population of 1.4 billion, In 2010, stroke ranks number 1 in rural areas and number 3 in urban. Advances in stroke prevention and treatment resulting in mortality declined significantly, which leads to more people living with residual disability. The health care system is challenged due to limited financial and specialized human resources. It is well known that rehabilitation plays a pivotal role in functional recovery of stroke survivors. Rehabilitation is a process aimed at enhancing functional performance and resorting greater independence in activities of daily living (ADL), further more, help patients to live both independently and productively, thus greatly reducing the social and economic burdens on society and their families. Onset admission interval (OAI) or initiation of rehabilitation, was defined as the time between stroke onset and admission to post-stroke rehabilitation program. The relationship between OAI and rehabilitation outcomes has been repeatedly documented. Many researches prove that individuals with stroke who are admitted earlier to stroke rehabilitation programs was associated significantly with better functional outcomes:higher total, motor, mobility, and ADL discharge, FIM scores. Further more, earlier OAI also associated significantly with shorter length of rehabilitation stay (LORS).Length of rehabilitation stay (LORS) or duration of rehabilitation after stroke was defined as the time between start of rehabilitation and discharge or to other residential institution. LORS has reliable implications for patients recovering from stroke, Which allow patients, families, and clinicians to predict when patients might return to their families or communities. From an administrative or health economics perspective, LORS is an important meaningful marker for efficiency and is a principal target for cost containment. Many researchers had demonstrated that costs were highly correlated with the LORS. Rehabilitation therapy based on western medicine is introduced into China in recent thirty years, It has been accepted extensively and obtained quite great development. To the best of our knowledge, few studies have been conducted to examine the current status of post-stroke rehabilitation in China, the actual circumstances are not well known to the rest of the world.Objective:Rehabilitation plays a pivotal role in functional recovery of stroke survivors, onset admission interval (OAI) and length of rehabilitation stay (LORS) are sensitive quantitative indexes that measures post-stroke efficiency and utilization. Aim of this primary research is to describe the distribution features of OAI and LORS after stroke in a medium-sized city in China, and explore the discrepancies of OAI and LORS in different frequency and nature of post-stroke patients. Fully understanding the status of stroke rehabilitation might help the healthcare administrator to construct more effective policies.Methods:This is a retrospective study of the post-stroke patients, No protocols or experimental were done before. According to national guidelines, all patients were diagnosed and treated at the hospital and not for the purpose of any study. all data were extracted from the Hospital Information System (HIS) during January 2011 and October 2013. Every patient who received rehabilitation treatment has a medical record. Hospital clinical records were then retrospectively examined in HIS. Selection Criteria:(1)18 years of age or older (2) with stroke symptom, and diagnosed as ischemic stroke or hemorrhage or both (3) received rehabilitation treatment (for limb function or swallowing restriction or central facial palsy or aphasias).Enrolled patients accepted comprehensive rehabilitation therapy, including physical therapy (PT) occupation therapy(OT) and speech and language therapy(SLT). Psychotherapy and rehabilitation engineering were also available as required. Individual PT OT and SLT were provided six days per week.Results:(1) Clinical characteristics of enrolled patients. The mean age of the patients was 62.61±12.58 years, with 81.9% between 50 to 80 years old and 63.0% were males. The majority of the patients were first-ever stroke (71.7%).Ischemic stroke was found in 74.9% of patients, and 45.4% was left side hemiplegia. The major risk factor history was hypertension(79.2%), followed by smoking (35.7%),drinking(35.2%),coronary heart disease(30.1%), diabetes mellitus (26.9%), and hyperlipidemia(6.9%).(2) Distribution of OAI and LORS after stroke. Approximately 54% of post-stroke patients OAI were 7 to 21 days, Almost 26% did not begin until 28 days or more, about 11% was 7 days or less, only less than 9% was 21 to 28 days. The mean time of OAI was 23.78±26.09 days (rangedl-180d). As to LORS, over 34% of post-stroke patients LORS was 7 days or less, Approximately 28% was 7 to 14 days, about 15% was 14 to 21days,and over 14% patients recovery time was more than 28 days, about 7% was 21 days to 28 days. The mean time of LORS was 17.24±24.54 days (rangedl-337 d).(3) Comparison of OAI with different type of post-stroke patients. The differences of OAI in frequency of stroke were statistically significant (P<0.05).The earlier OAI was second attack of stroke patients (19.26d), followed by more than two times (24.95d) and first-ever (25.13d). With respect to the differences in nature of stroke were statistically significant (P<0.01). The earlier OAI was ischemic stroke patients (21.38d), followed by hemorrhagic (29.38d) and both kinds (35.33d).(4) Comparison of LORS with different type of patients. The differences of LORS in frequency of stroke were statistically significant (P<0.01).The longer LORS was first-ever stroke patients (19.25d), followed by more than two times (16.16d) and second (11.21d). With respect to the differences in nature of stroke patients were statistically significant (P<0.01).The longer LORS was hemorrhagic stroke patients (23.11d), followed by ischemic (15.96 d) and both kinds (15.28 d).Conclusions:In China, post-stroke rehabilitation began as later OAI and ended as shorter LORS compared with other countries. Reinforce the rehabilitation concept of medical professionals as well as the public and adjust medical insurance status are urgent.[Purpose] Neuromuscular electrical stimulation(NMES) has been used in poststroke rehabilitation for a long time. Many studies have reported on the effect of NMES in prevention of muscle atrophy, decrease of spasticity, increase of muscle strength, and facilitation of recovery of functional movement. However,performing NMES in daily practice is challenging because of differences with respect to stimulation characteristics: technique, frequency,intensity and duration Best choice,for the rehaWlitation of the paretic upper extremity is still unclear. 12-hours neuromuscular electrical stimulation (12h-NMES) maybe a new alternative therapeutic approach, which treatment was assigned in the evening when subjects wore a portable device remained at rest or sleep. Intensity of the electrical current was adjusted to produce slight contraction of the target muscle without inducing obvious limb/joint movement while the subject remained comfortable and not distracted by the stimulation. The purpose of this trial was to evaluate the effectiveneto of long-duration(12 hours in the evening) low-intensity(electrical current produce slight contraction of the target muscle) NMES on upper extremity function of stroke patients.[Subjects and Methods] This study was a single-blinded randomized controlled trial with 4 weeks follow-up. One hundred and thirty-two patients who had developed hemiplegia as Ksult of stroke west Kcraited from hospital from July2012 May 2014. Forty-five subjects were randomized to one of three groups:12h-NMES group (12h NMES+ conventional rehabilitation,n= 15); NMES group Omin NMES+ COnventional rehaWlitation,n=15); Control group(conventional rehabilitation,n=15).Eligible subjects togardlsss of their group assignment underwent standard inpatient rehabilitation that included physical therapy,occupational therapy,activities of daily living, mobility training and speech therapy. Additional, the patients in the 12h-NMES and NMES group received electric stimulation treatment 12h/30min,4week,6 days/week schedule The amplitude of the current in toe NMES group was adjusted to obtain mdidmum range of wrist and finger extension without discomfort,and in 12h-NMES group,the intensity was adjusted to produce slight contraction of muscle wito invistole limb/joint movement while the subject remained comfortable and not distracted by the stimulation. Stimulation treatments were applied for 12 hours in the evening in the 12h-NMES group and 30 min in daytime in the NMES group. The FuglMeyer assessment (FMA),Action Rstearch Arm Test(ARAT), and Modisted Ashworth Score(MAS) were used to evaluate the effects before and after the intervention, as well as 4 weeks later.[Results] Forty subjects completed the treatment and follow-up process No adverse treatment effects, such as bums, skin allergic responses, increased muscle tone or obvious muscle fatigue, were noted. Patients showed good adherence ins study,only one in the 12h-NMES group denied treatment for toe affection onsleep quality. Four patients were 1st follow-up because of transportation difficulties and inconvenience. No significant difference was foimd in baseline characteristics among the groups.Significant improvements in the FMA-d were fbund in the 12h-NMES group compared with NMES group at week 4 and follow-up(T=2.89, P=0.007; T=3.01,P=0.003),also with the control group(T=4.59, P=0.000; T=2.18,P=0.04).Significant improvements in the FMA-p were obtained in the 12h-NMES group compared with control group at week 4 and follow-up(T=2.78, P=0.01; T=4.55,P=0.000),but not in the NMES group aIone(T=1.18,P=0.25;T=0.63,P=0.54).And there was no difference between the 2 NMES groups(T=1.41, P=0.17;T=1.20, P=0.43). Both NMES groups showed significant improvements in ARAT at week 4 and follow-up. Furthermore, the difference between the 2 NMES groups was significant.No significant difference was found in MAS for the elbow and the wrist flexor among the three groups at week 4 and follow-up. There was no evidence of exacerbation or alleviation of spasticity among the subjects, who showed mild tomoderate spasticity(MAS 1-2) in their elbow and waist.[Conclusion] 12h-NMES achieved better improvements of motor fimction in affected uppst extremity, especially in wrist/hand function. This strategy offers an alternative and easily applied therapeutic approach which may have particular approcation for patients during rest or sleep. |
