Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia

Time trends in ability level and functional outcome of stroke and multiple sclerosis patients undergoing comprehensive rehabilitation in Slovenia Background: The University Rehabilitation Institute in Ljubljana provides comprehensive rehabilitation for the whole territory of Slovenia. The aim of the study was to verify a clinical observation that the demandingness of rehabilitation has been increasing because of a decrease in patients' functional abilitites on admission, with rehabilitation outcomes having remained unchanged or even improved. Methods: Functional Independence Measure (FIM) scores of 651 cerebrovascular insult (CVI) and 151 multiple sclerosis (MS) patients gathered between September 2004 and September 2006 (all eligible cases) were compared with those for patients with the same diagnosis (N=144 and 74, respectively) collected during the period from September 1999 to September 2000 (a random sample), considering only first-admission cases. The average FIM (motor, cognitive and total) scores and FIM gain after rehabilitation during the two periods were determined for each diagnostic group adjusted for patient age. Rehabilitation efficiency and effectiveness levels were compared in the same way. Effect Size and Standardised Response Mean were also analysed. Results: There were no differences in gender structure of the groups between the periods studied. During the recent period, the average age was higher by around two years in both groups. The length of stay was marginally shortened for CVI patients and remained unchanged for MS patients. There were no differences between the two periods concerning the time elapsed since stroke. In both groups, admission motor and cognitive FIM scores were on average approximately five points lower in the recent period, while the average rehabilitation gain from admission to discharge increased over time (in total by 1 in CVI patients and by 3 in MS patients). Regarding motor and total FIM scores, the standardised gain, rehabilitation efficiency and rehabilitation effectiveness increased as well. Conclusions: The Institute is admitting more severely affected patients than it did five to ten years ago, and parallelly the patient age has increased. Despite that and notwithstanding the tendency towards shorter rehabilitation, expected age-adjusted functional independence gain, rehabilitation efficiency, rehabilitation effectiveness, and the standardised functional independence gain have increased. Časovne Spremembe Nivoja Zmožnosti In Funkcijskega Izida Bolnikov Po Možganski Kapi In Z Multiplo Sklerozo Na Celostni Rehabilitaciji V Sloveniji Izhodišča: Univerzitetni rehabilitacijski inštitut v Ljubljani nudi kompleksno rehabilitacijo za celotno ozemlje Slovenije. Želeli smo preveriti klinične izkušnje, da zahtevnost rehabilitacije narašča zaradi vse manjših funkcijskih zmožnosti bolnikov ob sprejemu, hkrati pa se izidi rehabilitacije ne slabšajo ali se celo izboljšujejo. Metode: Dosežke na Lestvici funkcijske neodvisnosti (Functional Independence Measure - FIM) pri 651 bolnikih po možganski kapi (CVI) in 151 bolnikih z multiplo sklerozo (MS), zbrane v obdobju IX/2004-IX/2006 (vsi ustrezni bolniki), smo primerjali z bolniki z istima diagnozama (N=144 in 74) iz obdobja IX/1999-IX/2000 (slučajni vzorec), pri čemer smo upoštevali le prve sprejeme. Povprečni dosežek na FIM (na motorični in kognitivni podlestvici ter skupni lestvici) in porast FIM po rehabilitaciji smo primerjali med obdobjema znotraj vsake diagnostične skupine, pri čemer smo odstranili vpliv starosti bolnikov. Učinkovitost in uspešnost rehabilitacije smo primerjali na enak način. Analizirali smo tudi velikost učinka in standardizirani povprečni odziv. Rezultati: Struktura spola se med obdobjema ni razlikovala v nobeni skupini. Povprečna starost je bila v obeh skupinah višja za okoli 2 leti v novejšem obdobju. Ležalna doba se je nekoliko skrajšala za bolnike s CVI, za bolnike z MS pa se ni spremenila. Čas od kapi se med obdobjema ni razlikoval. V obeh skupinah so bili dosežki na motorični in kognitivni podlestvici FIM ob sprejemu v povprečju za okoli 5 točk nižji v novejšem obdobju, hkrati pa se je povprečni porast od sprejema do odpusta povečal (skupaj za okoli 1 pri CVI in okoli 3 pri MS). Glede motoričnega in skupnega dosežka na FIM so se s časom povečali tudi standardizirani porast, učinkovitost rehabilitacije in uspešnost rehabilitacije. Zaključek: Na našem inštitutu sprejemamo zahtevnejše bolnike kot pred 5-10 leti, kar spremlja povečanje njihove starosti. Kljub temu in težnji po skrajševanju ležalne dobe so se pričakovani starostno neodvisni porast funkcijske neodvisnosti, učinkovitost rehabilitacije in uspešnost rehabilitacije povečali, kar velja tudi za standardizirani porast funkcijske neodvisnosti.

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