Abstrakt
We have established the network of Stroke Units with acute rehabilitation wards in Czech Republic only in 2012. Since that time, we try to unify functional assessment tools to compare the functional status of patients in different centers.
Long term goal is to predict which type of patients according to functional assessment will profit most from hospitalization on acute rehabilitation wards of stroke units. In 2017 the General Health Insurance Company supported a project in three centers in different part of Czech Republic to help in this process.
Method: The data were collected from April to November 2017, Barthel Index (BI), Extended BI (EBI), Functional independence measure (FIM) and International Classification of Functioning and Health (ICF) were measured the third and BRAIN INJURY 69 each fourteenth day after admission. The results were statistically processed and compared.
Results: 94 randomised patients were evaluated. Average age was 66,59 years, there were 55 men and 39 women included.
Average length of hospitalization was 23,4 days. One of the most important information was the place where the patient was dismissed.
We distinguish four categories - home, social facility, rehabilitation units or institutions with further rehabilitation and nursing care only. Patients who went home had FIM 100 and more, those who went to social facilities or Rehabilitation were FIM 60 - 80.
Patients who went to nursing homes had FIM 40 and less. Using BI plus EBI, patients with 170 points and more went home, 120 to social facilities, 130 to rehabilitation and those with 75 points went to nursing homes.
Very important was also the percentage of functional improvement during hospitalization of patients comparing with maximal values in different functional tests. In BI it was 15,92%, in FIM (motor part) 12,29%, in EBI 5,88%, in FIM (cognitive) 4,27%, in BI plus EBI 11,16% and FIM (total) 10,06%.
The biggest improvement was in the first 14 days. Conclusion: Some of the results are presumable and they will be of course found in literature.
But we have no such data in Czech Republic, and we need them for further negotiations with health insurance companies to convince them that intensive acute rehabilitation is the must and can minimize the disability of the patients after brain damage. Our up to date goal is to see as much patients from this group as possible after one year from dismission and try to work on predictive data which can help us to decide which patients are the best candidates for intensive acute rehabilitation.