Stroke is fatal 10-20% of the time (NIH). The majority of survivors return home from acute and subacute care settings with a rehabilitation program that they and their family caregivers are largely responsible for enacting. Yet research indicates adherence to such plans is far less than optimal.
The roles of physical therapy, occupational therapy, and speech therapy are essential in post stroke recovery, as are diet, medication, and exercise. We at SeniorBridge see a role for medically directed home care in which on-site home health professionals empower patients to “walk the talk” and follow their recovery plan.
The scope of non-compliance
Physical Therapy. “Non-adherence to physical rehabilitation therapies is often high – particularly in self-managed, home-based programs, despite good adherence being important in achieving positive outcomes.” said a 2017 “Disability and Rehabilitation” study. Non-adherence, it stated, can often reach 70%. Commonly cited reasons for non-compliance in PT and related “exercise programs” are emotional states such as sadness or anger, lack of motivation, musculoskeletal issues, and fatigue.
Medications. Medication compliance is also often less than desirable. A 2019 study in the International Journal of Environmental Research and Public Health indicated that only 68% of stroke survivors follow medication instruction, with the patient’s “perception of medication necessity” being a key factor. These patients are simply not convinced of the need for certain medications.
Occupational Therapy. Here, too, evidence of adherence is hard to find. “Many patients with stroke, brain injury, and spinal cord injury do not follow discharge recommendations or prescribed therapy protocols even though doing so is associated with optimal outcomes of care,” said a 2011 study in the American Journal of Occupational Therapy. “The rates of nonadherence to chronic illness regimens are estimated at 30%–60%, which is significantly worse than those for acute illness treatments.”
Speech and Language Therapy (SALT). Since 35% of people suffer from post stroke aphasia and 64%-78% experience a swallowing disorder, speech and language therapy is critical to recovery. Statistically valid research on compliance is scarce, although there are indications that adopting standardized guidelines for SALT improve post-stroke patient care and compliance.
Non compliance of patients to home exercise programs (HEP)
How home care enhances compliance
Deb Hess, SeniorBridge Director of Clinical Services, has extensive experience in working with post stroke patients in ICU, skilled nursing, and home health settings.
“After a stroke, people tend to do everything for the victim. But we know it's important to get their skills reactivated. So we let them finish their sentences, guiding them on how to use their tongue and shape words. Sometimes we use games to work on motor skills. We can make tasks fun. As long as it’s part of the MD’s orders, we can ‘wrap around’ the PT, OT and speech therapists to make sure the plan is being carried out.”
Regarding long-term recovery, she emphasized that “people go back to old habits. Sometimes their functionality peaks and therapeutic services are pulled back, even though gains can be made after six months. So we keep people actively engaged in their recovery long term.”
To summarize, while stroke patients are prone to lapses in their therapy programs, qualified home care professionals can maximize their engagement and their recovery.
After a stroke, people tend to do everything for the victim. But we know it's important to get their skills reactivated. So we let them finish their sentences, guiding them on how to use their tongue and shape words. Sometimes we use games to work on motor skills. We can make tasks fun.
The integrated care management model by SeniorBridge
Home care services vary widely in the services they provide.
SeniorBridge offers an integrated care management practice model that involves two components:
- Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
- A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.
NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.
For more information on hypertension home care support services, contact SeniorBridge.
Taylor Francis Online/Disability and Rehabilitation (2015)
ResearchGate/Topics in Stroke Rehabilitation (2011)
American Journal of Occupational Therapy (2011)
National Library of Medicine /NIH/Environmental Research and Public Health (2019)
BMC Health Services Research (2014)
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