Physical Therapy Korea
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Phys. Ther. Korea 2020; 27(1): 63-69
Published online February 20, 2020
https://doi.org/10.12674/ptk.2020.27.1.63
© Korean Research Society of Physical Therapy
뇌졸중 환자의 재활참여가 기능회복에 미치는 영향
원종임
전주대학교 의과학대학 물리치료학과
Impact of Patients' Level of Participation in Rehabilitation on Functional Outcome in Patients With Stroke
Jong-im Won 
, PhD, PT
Department of Physical Therapy, College of Medical Science, Jeonju University, Jeonju, Korea
Correspondence to: Jong-im Won
E-mail: ptwon@jj.ac.kr
https://orcid.org/0000-0002-6410-965X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Stroke recovery is a long and complex process. Successful stroke recovery seems to be strongly associated with patients' high motivation and committed participation. Patients' motivation is a key determinant of successful rehabilitation outcomes, but it is difficult in defining and measuring. Patients' participation is defined as the degree or extent to which subjects take part in rehabilitation activities and can be measured by observable behavior.
Objects: The purpose of this study was to investigate the impact of patients' level of participation in rehabilitation on functional outcomes in patients with stroke.
Methods: Forty post-stroke inpatients participated in this study. The level of rehabilitation participation was measured by the Hopkins Rehabilitation Engagement Rating Scale (HRERS). Other measures used for the evaluation were the Rivermead Mobility Index (RMI) and Korean version of the Modified Barthel Index (K-MBI). Overall measurements were made at early intervention and late intervention. Spearman correlation and multiple regression were used to measure the relationships between HRERS, RMI, and K-MBI.
Results: The correlation found between HRERS total scores at early intervention and RMI total scores of late intervention was above moderate (r = 0.607, p < 0.01). RMI total scores at early intervention (p < 0.000), HRERS total scores at early intervention (p < 0.001), and disease duration (p < 0.003) were significant predictors of RMI total scores at late intervention.
Conclusion: The level of participation at early intervention was associated with improvement in mobility. The level of mobility at early intervention, disease duration, and patients' participation at early intervention were important determinants of functional outcome. These findings suggest that patients' participation should be encouraged in order to achieve successful stroke recovery.
Keywords: Patient participation, Stroke rehabilitation, Treatment outcome
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ARTICLE
Phys. Ther. Korea 2020; 27(1): 63-69
Published online February 20, 2020 https://doi.org/10.12674/ptk.2020.27.1.63
Copyright © Korean Research Society of Physical Therapy.
뇌졸중 환자의 재활참여가 기능회복에 미치는 영향
원종임
전주대학교 의과학대학 물리치료학과
Impact of Patients' Level of Participation in Rehabilitation on Functional Outcome in Patients With Stroke
Jong-im Won , PhD, PT
Department of Physical Therapy, College of Medical Science, Jeonju University, Jeonju, Korea
Correspondence to:Jong-im Won
E-mail: ptwon@jj.ac.kr
https://orcid.org/0000-0002-6410-965X
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Stroke recovery is a long and complex process. Successful stroke recovery seems to be strongly associated with patients' high motivation and committed participation. Patients' motivation is a key determinant of successful rehabilitation outcomes, but it is difficult in defining and measuring. Patients' participation is defined as the degree or extent to which subjects take part in rehabilitation activities and can be measured by observable behavior.
Objects: The purpose of this study was to investigate the impact of patients' level of participation in rehabilitation on functional outcomes in patients with stroke.
Methods: Forty post-stroke inpatients participated in this study. The level of rehabilitation participation was measured by the Hopkins Rehabilitation Engagement Rating Scale (HRERS). Other measures used for the evaluation were the Rivermead Mobility Index (RMI) and Korean version of the Modified Barthel Index (K-MBI). Overall measurements were made at early intervention and late intervention. Spearman correlation and multiple regression were used to measure the relationships between HRERS, RMI, and K-MBI.
Results: The correlation found between HRERS total scores at early intervention and RMI total scores of late intervention was above moderate (r = 0.607, p < 0.01). RMI total scores at early intervention (p < 0.000), HRERS total scores at early intervention (p < 0.001), and disease duration (p < 0.003) were significant predictors of RMI total scores at late intervention.
Conclusion: The level of participation at early intervention was associated with improvement in mobility. The level of mobility at early intervention, disease duration, and patients' participation at early intervention were important determinants of functional outcome. These findings suggest that patients' participation should be encouraged in order to achieve successful stroke recovery.
Keywords: Patient participation, Stroke rehabilitation, Treatment outcome
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Demographic characteristics of the participants (N = 40).
Variable Value Age (y) 57.2 ± 15.5 Sex (male/female) 20/20 Hemiplegic side (right/left) 11/29 Type of stroke (ischemia/hemorrhage) 30/10 Disease duration (d) 20.1 ± 12.8 Mini-Mental State Examination 26.8 ± 2.4 Values are presented as mean ± standard deviation or number only..
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Comparison of the clinical assessments scores between early and late intervention.
Measure Early intervention Late intervention±p-value HRERS 21.4 ± 4.0 23.3 ± 4.4 RMI 5.3 ± 4.4 8.6 ± 3.9 K-MBI 47.5 ± 18.2 62.9 ± 22.7 Values are presented as mean ± standard deviation. HRERS, Hopkins Rehabilitation Engagement Rating Scale; RMI, Rivermead Mobility Index; K-MBI, Korean version of the Modified Barthel Index..
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Correlation for clinical variables at early and late intervention.
Measure HRERS-E RMI-E K-MBI-E HRERS-L RMI-L K-MBI-L MMSE Disease duration HRERS-E RMI-E 0.465* * K-MBI-E 0.031 0.549* * HRERS-L 0.836* * 0.448* * 0.148 RMI-L 0.607* * 0.748* * 0.491* * 0.526* * K-MBI-L –0.087 0.295 0.747* * 0.181 0.341* MMSE 0.334* 0.339* 0.113 0.435* * 0.338* 0.055 Disease duration 0.176 0.153 –0.108 0.230 –0.051 –0.127 0.340* Age (y) –0.026 –0.129 –0.081 –0.017 –0.158 –0.018 –0.586* * –0.266 HRERS-E, Hopkins Rehabilitation Engagement Rating Scale at early intervention; RMI-E, Rivermead Mobility Index at early intervention; K-MBI-E, Korean version of the Modified Barthel Index at early intervention; HRERS-L, Hopkins Rehabilitation Engagement Rating Scale at late intervention; RMI-L, Rivermead Mobility Index at late intervention; K-MBI-L, Korean version of the Modified Barthel Index at late intervention; MMSE, Mini-Mental State Examination. * p < 0.05, ** p < 0.01..
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Multiple regression analysis of factors predicting RMI scores at late intervention.
Measure Standardised coefficient (beta) p-value RMI-E 0.60 0.000 HRERS-E 0.40 0.001 Disease duration –0.30 0.003 RMI-E, Rivermead Mobility Index at early intervention; HRERS-E, Hopkins Rehabilitation Engagement Rating Scale at early intervention..
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Multiple regression analysis of factors predicting HRERS scores at late intervention.
Measure Standardised coefficient (beta) p-value HRERS-E 0.76 0.000 MMSE 0.24 0.008 HRERS-E, Hopkins Rehabilitation Engagement Rating Scale at early intervention; MMSE, Mini-Mental State Examination..