Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship
Abstract Objectives To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4)...
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| Veröffentlicht in: | Archives of physical medicine and rehabilitation 2013-09, Vol.94 (9), p.1837-1841 |
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| creator | Altman, Irwin M., PhD, MBA Swick, Shannon, MA Malec, James F., PhD, ABPP-Cn, Rp |
| description | Abstract Objectives To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting HCBR conducted in 7 geographically distinct U.S. cities. Participants Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. Intervention HCBR delivered by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. Results With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P |
| doi_str_mv | 10.1016/j.apmr.2013.02.014 |
| format | Article |
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Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting HCBR conducted in 7 geographically distinct U.S. cities. Participants Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. Intervention HCBR delivered by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. Results With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P <.001) with a moderate effect size (partial η2 =.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P <.001; partial η2 =.08), Adjustment (F=99.67, P <.001; partial η2 =.10), and Participation (F=69.15, P <.001; partial η2 =.07). Conclusions Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.</description><identifier>ISSN: 0003-9993</identifier><identifier>EISSN: 1532-821X</identifier><identifier>DOI: 10.1016/j.apmr.2013.02.014</identifier><identifier>PMID: 23462581</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age Factors ; Cerebrovascular accident ; Community Health Services - statistics & numerical data ; Female ; Home Care Services - statistics & numerical data ; Humans ; Male ; Middle Aged ; Physical Medicine and Rehabilitation ; Rehabilitation ; Retrospective Studies ; Sex Factors ; Stroke ; Stroke Rehabilitation ; Time Factors</subject><ispartof>Archives of physical medicine and rehabilitation, 2013-09, Vol.94 (9), p.1837-1841</ispartof><rights>American Congress of Rehabilitation Medicine</rights><rights>2013 American Congress of Rehabilitation Medicine</rights><rights>Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-cf801f23173e0007c26a9a3df8ac38372a465a979590f1748384205d70d344f43</citedby><cites>FETCH-LOGICAL-c411t-cf801f23173e0007c26a9a3df8ac38372a465a979590f1748384205d70d344f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0003999313001391$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23462581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Altman, Irwin M., PhD, MBA</creatorcontrib><creatorcontrib>Swick, Shannon, MA</creatorcontrib><creatorcontrib>Malec, James F., PhD, ABPP-Cn, Rp</creatorcontrib><title>Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship</title><title>Archives of physical medicine and rehabilitation</title><addtitle>Arch Phys Med Rehabil</addtitle><description>Abstract Objectives To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting HCBR conducted in 7 geographically distinct U.S. cities. Participants Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. Intervention HCBR delivered by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. Results With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P <.001) with a moderate effect size (partial η2 =.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P <.001; partial η2 =.08), Adjustment (F=99.67, P <.001; partial η2 =.10), and Participation (F=69.15, P <.001; partial η2 =.07). Conclusions Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Cerebrovascular accident</subject><subject>Community Health Services - statistics & numerical data</subject><subject>Female</subject><subject>Home Care Services - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Physical Medicine and Rehabilitation</subject><subject>Rehabilitation</subject><subject>Retrospective Studies</subject><subject>Sex Factors</subject><subject>Stroke</subject><subject>Stroke Rehabilitation</subject><subject>Time Factors</subject><issn>0003-9993</issn><issn>1532-821X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks2O0zAUhS0EYkrhBVggL9kk47_8IYQ0dDoMUiXQABI7y3FuqEsSB9-kUl-I58ShAwsWrGzL5ztX955LyHPOUs54fnlIzdiHVDAuUyZSxtUDsuKZFEkp-NeHZMUYk0lVVfKCPEE8xGeeSf6YXAipcpGVfEV-btsW7OSOMAAi9S299T0k1AwN3fi-nwc3nZK3BqGhd7A3tevcZCbnB-oGaujOhG8QlXsfpoX-GP9gmJBeOzR1F6n6RDcQoA7-aNDOnQn0ylrXRNUruj0uFwsLaui1R0juAEc_IMRy3e9CuHfjU_KoNR3Cs_tzTb7cbD9vbpPdh3fvN1e7xCrOp8S2JeOtkLyQELstrMhNZWTTlsbKUhbCqDwzVVFlFWt5oUpZKsGypmCNVKpVck1enn3H4H_MgJPuHVroOjOAn1FzJUpRsCzOcU3EWWqDRwzQ6jG43oST5kwv-eiDXvLRSz6aCR3zidCLe_-57qH5i_wJJApenwUQuzw6CBqtWybUuBBz0o13__d_8w9uOzc4a7rvcAI8-DkMcX6aa4yA_rRsyLIgXLLoUnH5C0gYtuI</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Altman, Irwin M., PhD, MBA</creator><creator>Swick, Shannon, MA</creator><creator>Malec, James F., PhD, ABPP-Cn, Rp</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130901</creationdate><title>Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship</title><author>Altman, Irwin M., PhD, MBA ; Swick, Shannon, MA ; Malec, James F., PhD, ABPP-Cn, Rp</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-cf801f23173e0007c26a9a3df8ac38372a465a979590f1748384205d70d344f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Cerebrovascular accident</topic><topic>Community Health Services - statistics & numerical data</topic><topic>Female</topic><topic>Home Care Services - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Physical Medicine and Rehabilitation</topic><topic>Rehabilitation</topic><topic>Retrospective Studies</topic><topic>Sex Factors</topic><topic>Stroke</topic><topic>Stroke Rehabilitation</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Altman, Irwin M., PhD, MBA</creatorcontrib><creatorcontrib>Swick, Shannon, MA</creatorcontrib><creatorcontrib>Malec, James F., PhD, ABPP-Cn, Rp</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of physical medicine and rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Altman, Irwin M., PhD, MBA</au><au>Swick, Shannon, MA</au><au>Malec, James F., PhD, ABPP-Cn, Rp</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship</atitle><jtitle>Archives of physical medicine and rehabilitation</jtitle><addtitle>Arch Phys Med Rehabil</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>94</volume><issue>9</issue><spage>1837</spage><epage>1841</epage><pages>1837-1841</pages><issn>0003-9993</issn><eissn>1532-821X</eissn><abstract>Abstract Objectives To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. Design Retrospective analysis of program evaluation data for treatment completers and noncompleters. Setting HCBR conducted in 7 geographically distinct U.S. cities. Participants Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. Intervention HCBR delivered by certified professional staff on an individualized basis. Main Outcome Measures Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. Results With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P <.001) with a moderate effect size (partial η2 =.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P <.001; partial η2 =.08), Adjustment (F=99.67, P <.001; partial η2 =.10), and Participation (F=69.15, P <.001; partial η2 =.07). Conclusions Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23462581</pmid><doi>10.1016/j.apmr.2013.02.014</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Age Factors Cerebrovascular accident Community Health Services - statistics & numerical data Female Home Care Services - statistics & numerical data Humans Male Middle Aged Physical Medicine and Rehabilitation Rehabilitation Retrospective Studies Sex Factors Stroke Stroke Rehabilitation Time Factors |
| title | Effectiveness of Home- and Community-Based Rehabilitation in a Large Cohort of Patients Disabled by Cerebrovascular Accident: Evidence of a Dose-Response Relationship |
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