Introduction: This trial work is the result of a collaboration with a national study of taxonomy of neurorehabilitation interventions managed by the Don Gnocchi Foundation in Milan. An observational longitudinal cohort study was conducted on patients with acute stroke in the Neurorehabilitation Clinic of AOU Ospedali Riuniti in Ancona, satellite centre of the national taxonomy study, because of the absence of a shared approach in post-stroke rehabilitation. Given the high incidence rate and the level of disability following stroke, attention was paid to the prevalence of goals and rehabilitation interventions and to the patients’ perception of their health and quality of life. Objectives: - Explaining goals and content of rehabilitation treatments carried out within the Neurorehabilitation Clinic of Ancona in patients with acute stroke - Describing if and how rehabilitative goals change according to the variation of setting and patient’s clinical phase - Monitoring the effects of therapies on locomotion with the aim of correlating the variation of the outcome measures used with the type of rehabilitation performed - Investigating the patients’ perception of health, safety and quality of life Materials and methods: 14 patients were involved, 12 of whom met the inclusion criteria: diagnosis of ischemic or haemorrhagic acute stroke, age ≥18, ability to understand the study protocol and participate voluntarily, planned duration of treatment of at least 10 sessions, distributed between morning (120 minutes) and afternoon (40 minutes) and signature of informed consent. To compare the prevalence of the acute goals with chronic ones 13 additional patients with the same inclusion criteria (except for the clinical phase) were considered, the data of which were taken from national study database. Data collection from January to August 2021 included pre and post treatment evaluations of impairment level, functional capacity, ADL and quality of life and the compilation of a specific taxonomy sheet of goals and interventions. Analysis of the results: The most frequent goals have been gait, handling/grip and balance recovery, both in acute and chronic phase. In the Clinic of Ancona, for the ambulation recovery, treatments included mainly gait cycle, aid and balance training. Major improvements in post-rehabilitation evaluations have been recorded doing aid and aerobic training, muscle recruitment and stretching exercises, balance and gait cycle training. For the goal of handling/grip dual-task, fine-grip and proprioceptive exercises were frequent. For the recovery of balance proprioceptive exercises, balance training and postural alignment have been performed with greater frequency. At the end of rehabilitation all patients perceived increased health condition and autonomy in ADL and more safety and maintenance of balance in different daily life contexts. Discussion: The analysis shows an improvement at the motor and psychological level after treatments for all patients. According to the guidelines, the goals aim to achieve the maximum possible autonomy in ADL. Interventions followed the task-oriented and tailored approach, favoring functional recovery, person’s attention and interest. Patients and family were informed and educated in the assistance by a multi-professional and interdisciplinary team. All involved people perceived an improvement. Conclusions: Although the small sample doesn’t allow a generalization to a wider context a taxonomy for patients with acute stroke of the AOU Ospedali Riuniti of Ancona was achieved. The comparison between acute and chronic objectives showed a continuity, because the most frequent goals were the same. The approach in an environment enriched with tools of daily life, shared by physiotherapists and in accordance with the guidelines, led to motor and psychological improvements
Questo elaborato sperimentale nasce da una collaborazione con uno studio nazionale di tassonomia in neuroriabilitazione che fa capo alla Fondazione Don Gnocchi di Milano.È stato condotto uno studio di tipo osservazionale longitudinale di coorte su pazienti con esiti di ictus in fase acuta presso la Clinica di Neuroriabilitazione dell’AOU di Ancona,centro satellite dello studio nazionale.L’idea deriva dalla volontà di studiare la prevalenza di obiettivi e trattamenti riabilitativi effettuati,dati l’alto tasso di incidenza e il livello di disabilità post-stroke oltre all’assenza di un approccio riabilitativo condiviso.È stata indagata anche la percezione del paziente Obiettivi:Illustrare obiettivi e contenuto dei trattamenti riabilitativi effettuati presso la Clinica di Ancona nei pazienti con esiti di ictus acuto/Descrivere se e come variano gli obiettivi in base a setting e fase clinica/Monitorare gli effetti delle terapie sulla locomozione per correlare la variazione delle misure di outcome con il tipo di intervento riabilitativo effettuato/Indagare la percezione del paziente riguardo salute, sicurezza e qualità della vita Materiali e metodi:Sono stati coinvolti 14 pazienti, 12 dei quali hanno rispettato i criteri di inclusione prefissati:diagnosi di Stroke acuto,ischemico o emorragico,età ≥18 anni,capacità di comprendere il protocollo di studio e di partecipare volontariamente,durata della riabilitazione di almeno 10 sedute,distribuite tra mattina (120 minuti) e pomeriggio (40 minuti) e firma del consenso informato. Per poter confrontare la prevalenza degli obiettivi in fase acuta con quelli in fase cronica sono stati aggiunti 13 pazienti del database nazionale.La raccolta dei dati tra Gennaio ed Agosto 2021 ha previsto valutazioni pre e post trattamento riguardo menomazione, capacità funzionale, ADL e qualità della vita e la compilazione di un’apposita scheda di tassonomia Analisi dei risultati:Con maggiore frequenza sono stati prefissati come obiettivi il recupero della deambulazione, della manipolazione/presa e dell’equilibrio, sia in fase acuta che cronica.Presso la Clinica di Ancona, per il recupero del cammino, si sono effettuati principalmente training del passo e dell’equilibrio e addestramento all’ausilio.I miglioramenti maggiori nelle valutazioni post-riabilitazione rispetto a quelle pre si sono registrati con addestramento all’ausilio, allenamento aerobico, esercizi propedeutici di reclutamento muscolare e di stretching, training dell’equilibrio e del passo.Per la manipolazione/presa, sono stati frequenti esercizi dual-task, di presa fine e propriocettivi mentre per il recupero dell’equilibrio esercizi propriocettivi, training dell’equilibrio e allineamento posturale.Alla fine della riabilitazione i pazienti hanno percepito un miglioramento dello stato di salute e dell’autonomia nelle ADL, così come un incremento della sicurezza e dell’equilibrio in contesti quotidiani.Discussione:L’analisi mostra un miglioramento sia a livello motorio che psicologico dopo il trattamento per tutti i pazienti.Coerentemente alle linee guida, gli obiettivi prefissati sono rivolti al raggiungimento della massima autonomia possibile nelle ADL.I trattamenti hanno seguito l’approccio task-oriented e tailored, favorendo il recupero funzionale, l’attenzione e l’interesse della persona. I pazienti e la famiglia sono stati informati ed educati all’assistenza da parte di un team multiprofessionale ed interdisciplinare.Tutti i soggetti hanno percepito un miglioramento.Conclusioni:nonostante il campione ristretto non permetta una generalizzazione a un contesto più ampio è stato possibile realizzare una tassonomia relativa all'AOU di Ancona. Il confronto tra gli obiettivi in fase acuta e cronica ha mostrato una continuità, perché i più frequenti sono stati gli stessi. L'approccio è risultato condiviso dai fisioterapisti e in accordo con le linee guida
Obiettivi e trattamenti nella persona con esiti di ictus: tassonomia degli interventi riabilitativi e valutazione della percezione del paziente
BARTOLUCCI, SARA
2020/2021
Abstract
Introduction: This trial work is the result of a collaboration with a national study of taxonomy of neurorehabilitation interventions managed by the Don Gnocchi Foundation in Milan. An observational longitudinal cohort study was conducted on patients with acute stroke in the Neurorehabilitation Clinic of AOU Ospedali Riuniti in Ancona, satellite centre of the national taxonomy study, because of the absence of a shared approach in post-stroke rehabilitation. Given the high incidence rate and the level of disability following stroke, attention was paid to the prevalence of goals and rehabilitation interventions and to the patients’ perception of their health and quality of life. Objectives: - Explaining goals and content of rehabilitation treatments carried out within the Neurorehabilitation Clinic of Ancona in patients with acute stroke - Describing if and how rehabilitative goals change according to the variation of setting and patient’s clinical phase - Monitoring the effects of therapies on locomotion with the aim of correlating the variation of the outcome measures used with the type of rehabilitation performed - Investigating the patients’ perception of health, safety and quality of life Materials and methods: 14 patients were involved, 12 of whom met the inclusion criteria: diagnosis of ischemic or haemorrhagic acute stroke, age ≥18, ability to understand the study protocol and participate voluntarily, planned duration of treatment of at least 10 sessions, distributed between morning (120 minutes) and afternoon (40 minutes) and signature of informed consent. To compare the prevalence of the acute goals with chronic ones 13 additional patients with the same inclusion criteria (except for the clinical phase) were considered, the data of which were taken from national study database. Data collection from January to August 2021 included pre and post treatment evaluations of impairment level, functional capacity, ADL and quality of life and the compilation of a specific taxonomy sheet of goals and interventions. Analysis of the results: The most frequent goals have been gait, handling/grip and balance recovery, both in acute and chronic phase. In the Clinic of Ancona, for the ambulation recovery, treatments included mainly gait cycle, aid and balance training. Major improvements in post-rehabilitation evaluations have been recorded doing aid and aerobic training, muscle recruitment and stretching exercises, balance and gait cycle training. For the goal of handling/grip dual-task, fine-grip and proprioceptive exercises were frequent. For the recovery of balance proprioceptive exercises, balance training and postural alignment have been performed with greater frequency. At the end of rehabilitation all patients perceived increased health condition and autonomy in ADL and more safety and maintenance of balance in different daily life contexts. Discussion: The analysis shows an improvement at the motor and psychological level after treatments for all patients. According to the guidelines, the goals aim to achieve the maximum possible autonomy in ADL. Interventions followed the task-oriented and tailored approach, favoring functional recovery, person’s attention and interest. Patients and family were informed and educated in the assistance by a multi-professional and interdisciplinary team. All involved people perceived an improvement. Conclusions: Although the small sample doesn’t allow a generalization to a wider context a taxonomy for patients with acute stroke of the AOU Ospedali Riuniti of Ancona was achieved. The comparison between acute and chronic objectives showed a continuity, because the most frequent goals were the same. The approach in an environment enriched with tools of daily life, shared by physiotherapists and in accordance with the guidelines, led to motor and psychological improvements| File | Dimensione | Formato | |
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Tesi_Bartolucci.pdf
embargo fino al 16/11/2024
Descrizione: Tesi di Sara Bartolucci
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1.31 MB | Adobe PDF |
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https://hdl.handle.net/20.500.12075/897