Project plan
Five studies are incorporated in the project CERISE. The first four studies are carried out to study several aspect of stroke rehabilitation (see introduction). The fifth study will bring together the results.
In each centre the pattern of recovery of 120 stroke patients will be documented. This study is
based on a standardised set of data, collected in each of the four rehabilitation
centres.
Measurements are performed on admission, at discharge, and at two, four and six
months after stroke resulting in assessments on five occasions on approximately 480 patients.
Inclusion criteria:
- A primary first ever stroke as revealed by rapidly developing clinical signs of focal or global disturbance or cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin (WHO-definition of stroke);
- Age between 40 and 85 years;
- Impaired gross motor function < or=11 on the Rivermead Motor Assessment; Impaired leg and trunk function < or = 8 on the Rivermead Motor Assessment;
Impaired arm function < or = 12 on the Rivermead Motor Assessment.
- Other neurological impairments with permanent damage such as previous head injury, MS, etc. and pre-stroke epileptic state or previous strokes;
- Stroke like symptoms due to subdural haematoma, haemorrhage caused by tumour, encephalitis or trauma;
- No informed consent either from patient or family;
- Patients with a pre-stroke Barthel<50;
- Patients who are admitted to the rehabilitation centre more than 6 weeks post stroke. Patients are assessed at 5 different moments, namely at intake, at discharge, at 2, 4 and 6 months post stroke onset.
The aim of the second study is to identify differences in the provision of stroke services in the
four centres. The observation record is based on time sampling of activities. This record is used
to register the activities, locations and social interaction of 60 patients on a random sample of
30 days in each centre.
The timing of recording is randomly selected, but covers early
shifts (7 a.m. to 12 noon), midday shifts (12 noon to 5 p.m.) and late shifts (5 p.m. to 10 p.m.)
Fifteen physiotherapy and 15 occupational therapy treatment sessions will be videotaped. The recordings are made on 30 stroke patient (also included in study 1) on the basis of strict selection criteria. The content of interventions will be logged to unpack the black box of physical and occupational therapy.
Analysis of the organisational characteristics of the different units providing rehabilitation
requires the determination of the relative input of man-hours, the personnel and task
characteristics for different patterns of organisation of stroke services and their respective
relation to outcome.
The structural analysis focuses on management (pathway, planning,
control system, etc.), task characteristics (standardisation of tasks, amount of formalism in
organising the work), staff characteristics (level of specialisation of staff, structure of labour
division, etc.) and physical environment (location, architecture, facilities, etc.).
The
data are collected by quantitative and qualitative methods.
The pattern of recovery in the various centres will be compared. Case mix will be used to control
for the variation between patients treated in the four different settings. We will be able to
identify which centre generates the best outcome.
Multivariate analysis will be used to
explore factors that contribute to the difference in outcome. Finally the best clinical practice in
stroke rehabilitation will be identified.
