Effectiveness of Accessible Home Arrangements in the Post-Stroke Period

Year 2022, Volume: 10 Issue: 1, 1 - 10, 28.01.2022

Didem Gök Gulsah Kınalı

https://doi.org/10.30720/ered.818984

Abstract

Purpose: In this study, it was aimed to examine the effect of accessible home arrangements on recovery after stroke.
Material and Method: Sixty patients admitted to Adana Seyhan State Hospital with acute stroke were included in the study (n=30, control group; n=30 study group). Brunnstrom assessment was used to evaluate motor recovery, Functional Independence Scale was used to determine functional level, Barthel Index was used to evaluate activities of daily living, and Beck Depression Inventory was used to determine depression level. For home accessibility assessment and regulation, a form was created that includes universal design standards and daily living activity aids. The patient's family was educated about the arrangements to be made at home. Home accessibility was evaluated in the study group before and after the training. Motor recovery, functionality, activities of daily living and depression level were evaluated in both groups at the beginning of the study, at the end of the 1st month and at the end of the 2nd month.
Results: There was no significant change in upper extremity motor recovery in the study group with home accessibility adjustment (p=0.29). Lower extremity motor recovery (p=0.01), functional independence level (p=0.03), activities of daily living (p=0.04) increased statistically significantly. Depression level decreased statistically significantly (p=0.01).
Discussion: In the post-stroke period, education on home accessibility arrangements should be given to patients and their relatives. Hospitals should employ experts who can provide training on this subject, and home accessibility control, training and regulation services should be included in home care programs.

Keywords

Stroke, universal design, home discharge, accesibility, house arrangements

İnme Sonrası Dönemde Erişilebilir Ev Düzenlemelerinin Etkinliği

Abstract

Amaç: Bu çalışmada inme sonrası iyileşmede erişilebilir ev düzenlemelerinin etkisinin incelenmesi amaçlandı.
Gereç ve Yöntem: Adana Seyhan Devlet Hastanesi'ne akut inme ile başvuran 60 hasta çalışmaya dahil edildi (n=30, kontrol grubu; n=30 çalışma grubu). Motor iyileşmeyi değerlendirmek için Brunnstrom değerlendirmesi, fonksiyonel seviyeyi belirlemek için Fonksiyonel Bağımsızlık Ölçeği, günlük yaşam aktivitelerini değerlendirmek için Barthel İndeksi ve depresyon düzeyini belirlemek için Beck Depresyon Envanteri kullanıldı. Ev erişilebilirlik değerlendirme ve düzenlemesi için, evrensel tasarım standartlarını ve günlük yaşam aktivite yardımcı malzemelerini içeren bir form oluşturuldu. Hasta ailesine evde yapılması gereken düzenlemeler hakkında eğitim verildi. Çalışma grubunda eğitim öncesi ve sonrası ev erişilebilirliği değerlendirildi, her iki grupta motor iyileşme, fonksiyonellik, günlük yaşam aktiviteleri ve depresyon düzeyi çalışma başlangıcında, 1. Ay sonunda ve 2. Ay sonunda değerlendirildi.
Sonuçlar: Ev erişilebilirlik düzenlemesi yapılan çalışma grubunda üst ekstremite motor iyileşmesinde anlamlı bir değişiklik olmadı (p=0,29). Alt ekstremite motor iyileşmesi (p=0,01), fonksiyonel bağımsızlık düzeyi (p=0,03), günlük yaşam aktiviteleri düzeyi(p=0,04) istatistiksel olarak anlamlı derece arttı. Depresyon düzeyi ise istatistiksel olarak anlamlı derecede azaldı (p=0,01).
Tartışma: İnme sonrası dönemde, hasta ve hasta yakınlarına ev erişilebilirlik düzenlemeleri eğitimi verilmelidir. Hastaneler bu konuda eğitim verebilecek uzmanları istihdam etmeli, evde bakım programlarının içine ev erişilebilirlik kontrolü, eğitimi ve düzenleme hizmetleri dahil edilmelidir.

Keywords

inme, ev düzenlemeleri, evrensel tasarım, erişilebilirlik, taburculuk

References

• Ahmed, S., Mayo, N. E., Higgins, J., Salbach, N. M., Finch, L., & Wood-Dauphinée, S. L. (2003). The Stroke Rehabilitation Assessment of Movement (STREAM): A comparison with other measures used to evaluate effects of stroke and rehabilitation. Phys Ther, 83(7), 617-630. https://doi.org/10.1093/ptj/83.7.617
• Akulwar, I., & Shahane, N. (2017). Perceived environmental barriers to community participation in stroke patients. IJSR, 6, 1675-1679.
• Altuntaş, O., & Kayıhan, H. (2015). Ev düzenlemelerinin yaşlıların yaşam kalitesine etkisi. Turk J Physiother Rehabil, 26(1), 1-13.
• Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
• Bergström, A. L., von Koch, L., Andersson, M., Tham, K., & Eriksson, G. (2015). Participation in everyday life and life satisfaction in persons with stroke and their caregivers 3–6 months after onset. J Rehabil Med, 47(6), 508-515. DOI: 10.2340/16501977-1964
• Cameron, J. I., Tsoi, C., & Marsella, A. (2008). Optimizing stroke systems of care by enhancing transitions across care environments. Stroke, 39(9), 2637-2643. DOI: 10.1161/STROKEAHA.107.501064
• Chun, H. Y. Y., Whiteley, W. N., Dennis, M. S., Mead, G. E., & Carson, A. J. (2018). Anxiety after stroke: the importance of subtyping. Stroke, 49(3), 556-564. DOI: 10.1161/STROKEAHA.117.020078
• Çiftçi, İ., & Çağlayan Gümüş, D. (2017). Erişilebilirlik İzleme ve Denetleme Formları. Ankara, Başak Matbaacılık.
• Drummond, A., Whitehead, P., Fellows, K., Edwards, C., & Sprigg, N. (2012). Occupational therapy predischarge home visits for patients with a stroke: What is national practice?. Br J Occup Ther, 75(9), 396-402. https://doi.org/10.4276/030802212X13470263980711
• Duncan, P. W., Goldstein, L. B., Matchar, D., Divine, G. W., & Feussner, J. (1992). Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke, 23(8), 1084-1089. https://doi.org/10.1161/01.STR.23.8.1084
• Ellis-Hill, C. S., & Horn, S. (2000). Change in identity and self-concept: A new theoretical approach to recovery following a stroke. Clin Rehabil, 14(3), 279-287. https://doi.org/10.1191/026921500671231410
• Fydrich, T., Dowdall, D., & Chambless, D. L. (1992). Reliability and validity of the Beck Anxiety Inventory. J Anxiety Dis, 6(1), 55-61. https://doi.org/10.1016/0887-6185(92)90026-4
• Garin, N., Olaya, B., Miret, M., Ayuso-Mateos, J. L., Power, M., Bucciarelli, P., et al. (2014). Built environment and elderly population health: A comprehensive literature review. Clin. Pract. Epidemiol, 10, 103-115. doi: 10.2174/1745017901410010103
• Hormozi, S., Alizadeh-Khoei, M., Sharifi, F., Taati, F., Aminalroaya, R., Fadaee, S., et al. (2019). Iranian version of Barthel Index: validity and reliability in outpatients' elderly. Int J Prev Med, 10, 130-135. doi: 10.4103/ijpvm.IJPVM_579_18
• Huang, H. K., Lin, S. M., Yang, C. S. H., Liang, C. C., & Cheng, H. Y. (2017). Post-ischemic stroke rehabilitation is associated with a higher risk of fractures in older women: A population-based cohort study. PloS One, 12(4), e0175825. https://doi.org/10.1371/journal.pone.0175825
• Hugues, A., Di Marco, J., Janiaud, P., Xue, Y., Pires, J., Khademi, H., et al. (2017). Efficiency of physical therapy on postural imbalance after stroke: Study protocol for a systematic review and meta-analysis. BMJ Open, 7(1), e013348. http://dx.doi.org/10.1136/bmjopen-2016-013348
• Keysor, J. J., Jette, A. M., Coster, W., Bettger, J. P., & Haley, S. M. (2006). Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort. Arch Phys Med Rehabil, 87(12), 1566-1575. https://doi.org/10.1016/j.apmr.2006.08.347
• Kinali, G. (2017). Differencies in robotic rehabilitation according to clinic requirements. Medical Technologies National Congress (TIPTEKNO), (pp. 1-3).
• Kinali, G., Bilen, Ö., Doğanay, F., & Abakay, O. (2017). Digital accessibility in handicapped persons. Medical Technologies National Congress (TIPTEKNO) (pp. 1-3).
• Kinali, G., & Üçsular, F. D. (2018). Detection of early symptoms of cumulative trauma disorders among mothers of handicapped children: A pilot study. J Phys Ther Sci, 30(2), 196-200. https://doi.org/10.1589/jpts.30.196
• Kınalı, G. (2020). Rehabilitasyonda Topluma Katılımın İki Anahtarı: Erişilebilirlik Ve Evrensel Tasarım. Sosyal Politika Çalışmaları Dergisi, Erişilebilirlik Özel Sayısı (1) , 105-118. DOI: 10.21560/spcd.vi.818685
• Kınalı, G. (2021). Evrensel Tasarımın Kullanıldığı Alanlar, Rehabilitasyonda Evrensel Tasarım ve Herkes İçin Erişilebilirlik (ss 38-40), İstanbul: İstanbul Tıp Kitabevi.
• Kylén, M., Von Koch, L., Pessah-Rasmussen, H., Marcheschi, E., Ytterberg, C., Heylighen, A., & Elf, M. (2019). The importance of the built environment in person-Centred rehabilitation at home: study protocol. Int J Environ Res Public Health, 2019, 16(13), 2409. https://doi.org/10.3390/ijerph16132409
• Langhorne, P., & Widen-Holmqvist, L. (2007). Early supported discharge after stroke. J Rehabil Med, 39(2), 103-108. DOI: 10.2340/16501977-0042
• Langhorne, P., Coupar, F., & Pollock, A. (2009). Motor recovery after stroke: A systematic review. Lancet Neurol, 8(8), 741-754. DOI: 10.1016/S1474-4422(09)70150-4
• Lenzi, G. L., Altieri, M., & Maestrini, I. (2008). Post-stroke depression. Rev. Neurol, 164(10), 837-840. DOI: 10.1016/j.neurol.2008.07.010
• Li, X., Xia, X., Wang, P., Zhang, S., Liu, M., & Wang, L. (2017). Needs and rights awareness of stroke survivors and caregivers: A cross-sectional, single-centre questionnaire survey. BMJ Open, 7(10) e013210. DOI: 10.1136/bmjopen-2016-013210
• Marcheschi, E., Von Koch, L., Pessah‐Rasmussen, H., & Elf, M. (2018). Home setting after stroke, facilitators and barriers: A systematic literature review. Health Soc Care Community, 26(4), e451-e459. DOI: 10.1111/hsc.12518
• Miller, E. L., Murray, L., Richards, L., Zorowitz, R. D., Bakas, T., Clark, P., et al. (2010). Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: A scientific statement from the American Heart Association. Stroke, 41(10), 2402-2448. DOI: 10.1161/STR.0b013e3181e7512b
• Miller, K. K., Lin, S. H., & Neville, M. (2019). From hospital to home to participation: A position paper on transition planning poststroke. Arch Phys Med Rehabil, 100(6), 1162-1175. DOI: 10.1016/j.apmr.2018.10.017
• Mollaoğlu, M., Özkan Tuncay, F., & Kars Fertelli, T. (2011). İnmeli hasta bakım vericilerinde bakım yükü ve etkileyen faktörler. DEUHYO ED, 4(3): 125-130
• Norrving, B., & Kissela, B. (2013). The global burden of stroke and need for a continuum of care. Neurology, 80(3 Supplement 2), S5-S12. doi:10.1212/WNL.0b013e3182762397
• Oupra, R., Griffiths, R., Pryor, J., & Mott, S. (2010). Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand. Health Soc Care Community, 18(1), 10-20. doi:10.1111/j.1365-2524.2009.00865.x
• Öncü, J., Begoğlu, F., Durlanik, G., Kuran, B., & Doğu, B. (2014). Hemiplejik hastalarda el kemik mineral yoğunluğu ölçümleri ve klinik parametrelerle ilişkisi. Türk Fiz Tıp Rehab Derg, 60(4), 282-8. DOI: 10.5152/tftrd.2014.28003
• Paci, M., Nannetti, L., Casavola, D., & Lombardi, B. (2016). Differences in motor recovery between upper and lower limbs: does stroke subtype make the difference?. Int J Rehabil Res, 39(2), 185-187. DOI: 10.1097/MRR.0000000000000172
• Palstam, A., Sjödin, A., & Sunnerhagen, K. S. (2019). Participation and autonomy five years after stroke: A longitudinal observational study. PloS One, 14(7), e0219513. DOI: 10.1371/journal.pone.0219513
• Reinhardt, J. D., & Stucki, G. (2007). Rheumatoid arthritis and participation--the social animal revisited. J Rheumatol, 34(6), 1214-1216.
• Rochette, A., Desrosiers, J., & Noreau, L. (2001). Association between personal and environmental factors and the occurrence of handicap situations following a stroke. Disabil Rehabil, 23(13), 559–569. https://doi.org/10.1080/09638280010022540
• Sanford, J. A. (2012). Universal design as a rehabilitation strategy: Design for the ages. New York: Springer Publishing Company.
• Santana, S., Rente, J., Neves, C., Redondo, P., Szczygiel, N., Larsen, T., et al. (2017). Early home-supported discharge for patients with stroke in Portugal: A randomised controlled trial. Clin Rehabil, 31(2), 197-206. doi:10.1177/0269215515627282
• Soyuer, F., Ünalan, D., & Öztürk, A. (2007). İnme hastalarında yaş ve cinsiyetin fonksiyonel yetersizlik üzerine olan etkisi. Turgut Özal Tıp Merk Derg, 14(2): 91-94.
• Sturm, J. W., Dewey, H. M., Donnan, G. A., Macdonell, R. A., McNeil, J. J., & Thrift, A. G. (2002). Handicap after stroke: How does it relate to disability, perception of recovery, and stroke subtype? The North East Melbourne Stroke Incidence Study (NEMESIS). Stroke, 33(3), 762-768. doi:10.1161/hs0302.103815
• Sturm, J. W., Donnan, G. A., Dewey, H. M., Macdonell, R. A., Gilligan, A. K., & Thrift, A. G. (2004). Determinants of handicap after stroke: The North East Melbourne stroke incidence study (NEMESIS). Stroke, 35(3), 715-720. doi:10.1161/01.STR.0000117573.19022.66
• Yavuzer, G., Sonel, B., Tuncer, S., Süldür, N. (2001) İnmeli hastalarda üst ekstremite ve el fonksiyonlarının değerlendirilmesi. Türk Fiz Tıp Der, 47(3):38-43.
• Wee, J. (2009). Lysaght R. Factors affecting measures of activities and participation in persons with mobility impairment in persons with mobility impairment. Disabil Rehabil, 31, 1633-1642. doi:10.1080/09638280902736346
• Werngren-Elgström, M., Carlsson, G., & Iwarsson, S. (2009). A 10-year follow-up study on subjective well-being and relationships to person–environment (P–E) fit and activity of daily living (ADL) dependence of older Swedish adults. Arch Gerontol Geriatr, 49(1), e16-e22. doi:10.1016/j.archger.2008.08.001
• Wilson, C. M., Mitchell, C. L., & Hebert, K. M. (2017). Cerebellar stroke occupational therapy and physical therapy management from ıntensive care unit to outpatient: A case report. Cureus, 9(12), e1949. doi:10.7759/cureus.1949
• Wood, J. P., Connelly, D. M., & Maly, M. R. (2010). ‘Getting back to real living’: A qualitative study of the process of community reintegration after stroke. Clin Rehabil, 24(11), 1045-1056. doi:10.1177/0269215510375901