Abstract
Improvement the continuity of hospital to home-based rehabilitation for stroke patients at Sappasittiprasong HospitalBackground and PurposeStroke management is aimed at facilitating functional independence and community reintegration. Therefore, It would be logical that the sooner the patient can be returned home following stroke, the sooner the reintegration process can commence. The purpose of this study was to improve the continuity of hospital to home-based rehabilitation for stroke patients.MethodsAction research devised to 3 phases. This study was Phase 1 what showed situation analysis to identify problem. Prospective study collected data of patients and patients’ family who referred to Physical Therapy Department at Sappasitthiprasong Hospital. The data was collected by interview, indepth-interview, observation and focus group. The main outcome measure was Barthel Index (BI) for assessment activities daily living (ADL).ResultsThe problems were identify to problem of co-ordination in interdisciplinary team, problem of home visit service from home health care system, problem in lack of authority and problem of patients and caregiver. The most of patients were in rural area. There were 8 subjects who came to follow up from 20 subjects. Barthel Index score showed improvement when comparison of hospitalization period and 3 months followed up period (4.8, 12.2, respectively).Conclusion The continuity of rehabilitation system could improvement by the patient’s family member or other caregiver participated in rehabilitation from beginning and improved the co-ordination in interdisciplinary team.
