RESUMEN
PURPOSE: To determine the physiotherapy-related needs of people with stroke at discharge, 6 months after discharge, and 1 year after discharge from hospital, and to examine the results stratified by participants' acute Functional Independence Measure (FIM) scores. METHODS: A total of 241 adults with recent stroke were recruited into this longitudinal cohort study. As well as participating in a semi-structured interview that included questions about mobility needs and barriers, participants were asked to complete and return a closed-ended needs-assessment survey. RESULTS: During the interview, participants reported needs and barriers related to motor control, walking, stairs, fatigue, prevention of falls, and access to physiotherapy services. The survey identified many more needs, including transfers, wheelchair use, higher-level balance and mobility skills, and access to physiotherapy and suitable exercise facilities. Frequencies of needs and barriers tended to be lower among participants with higher acute FIM scores. There was no consistent trend for needs and barriers to decrease over time. CONCLUSIONS: Over the first year after discharge from hospital, people with stroke report a large and varied number of persistent mobility-related needs. Physiotherapists have a role to play in advocating for adequate follow-up services and informing health policy with respect to the needs of their patients with stroke.
Objectif : Établir les besoins en physiothérapie des personnes ayant subi un accident vasculaire cérébrale (AVC) lors de leur congé de l'hôpital, 6 mois après leur congé et 1 an après leur congé, et examiner les résultats stratifiés en fonction des pointages de mesure de l'autonomie fonctionnelle aigüe (Functional Independence Measure, FIM). Méthodologie : On a recruté en tout 241 adultes ayant récemment subi un ACV pour cette étude longitudinale de cohorte. En plus de participer à une entrevue semi-structurée comprenant des questions sur leurs besoins et sur les obstacles en matière de mobilité, les participants ont dû remplir et retourner un sondage d'évaluation des besoins avec questions fermées. Résultats : Au cours de l'entrevue, les participants ont fait part de besoins et d'obstacles liés au contrôle de leur motricité, à la marche, aux escaliers, à la fatigue, à la prévention des chutes et à l'accès à des services de physiothérapie. Le sondage a permis d'établir de nombreux autres besoins, dont la nécessité de transferts, l'utilisation d'un fauteuil roulant, un plus grand équilibre et de plus grandes habiletés motrices ainsi que l'accès à la physiothérapie et à des installations adaptées à leurs besoins en exercice. La fréquence des besoins et des obstacles avait tendance à diminuer chez les participants qui avaient obtenu des pointages plus élevés à l'échelle FIM. On n'a observé aucune tendance constante de diminution des besoins et des obstacles au fil du temps. Conclusions : Au cours de la première année suivant le congé de l'hôpital, les personnes qui ont subi un AVC font état d'un grand nombre de besoins variés et persistants en matière de mobilité. Les physiothérapeutes doivent faire pression pour des services de suivi adéquat et doivent contribuer à l'inclusion des besoins des patients qui ont subi un AVC dans les politiques en matière de santé.
RESUMEN
PURPOSE: To determine the needs, barriers and facilitators of function in individuals with stroke after discharge from hospital. To examine the results stratified by the patient's acute score (<41, 41-80, >80) on the functional independence measure (FIM). METHOD: This was a cohort study of 209 patients who had been admitted to hospital because of stroke. Patients were interviewed following hospital discharge using a semi-structured interview and asked to complete and return a quantitative closed-ended survey. RESULTS: For most domains, frequencies of needs varied across the FIM groups. Combining all FIM groups, the interview showed needs related to: physical impairments (35%), time for recovery (33%), education (28%), medical advice (25%), therapies and services (21%), social needs (19%) and emotional needs (18%). From the interview, the most frequent barriers were physical impairments (55%) and emotional concerns (40%). Common facilitators were family support (54%), therapies and medical care (40%) and personal attitudes (22%). Additional needs from the survey concerned: IADL, mobility, ADL, recreation, finances, communication and employment. Additional barriers from the survey were: attitudes, social participation, environments and limited services. CONCLUSIONS: There is a large and varied number of needs and barriers following discharge from hospital that have planning and advocacy implications for rehabilitation teams.