Case Study Report
Population: Adult
Valerie A Carter, PT, DPT, NCS, Associate Clinical Professor, Northern Arizona University Department of Physical Therapy and Athletic Training Valerie.Carter@nau.edu
Kay Wing, PT, DPT, NCS, GCS, Owner, SWAN Rehab, Phoenix, Arizona kay@swanrehab.com
Kim Gatewood, PT, DPT, NCS, Associate Clinical Professor, Northern Arizona University Department of Physical Therapy and Athletic Training Kim.Gatewood@nau.edu
Petra Williams, PT, PhD, NCS, Assistant Professor, Northern Arizona University Department of Physical Therapy and Athletic Training Petra.Williams@nau.edu
Keywords: Prevention, Stroke, Intensity, Value
BACKGROUND: Stroke is the leading cause of serious long-term disability. Annual post-stroke costs exceed $34 billion and will increase to $185 billion by 2030. Moderate to severe hemiparesis compromises mobility and diminishes quality of life with millions of dollars spent for long-term care, injurious falls and depression. After traditional in- and out-patient physical therapy in the first year, most do not receive periodic therapy to prevent decline in function. One explanation is the belief that the cost of periodic services in both actual healthcare dollars spent and effort required by patient and physical therapist are prohibitive relative to the potential gains in function. It is imperative that physical therapists demonstrate that ongoing therapy for stroke survivors will positively impact the lives of the patients we serve and the healthcare system as a whole.
PURPOSE: The purpose of this retrospective case series is to present outcome data and healthcare costs for people with moderate to severe long term disability after stroke who have participated annually in an intensive 30-hour 5-day whole body intervention program over the past 13 years. We will show that individuals with moderate to severe hemiparesis who have participated in this program have a greater quality of life and reduced overall costs to the healthcare system compared to data available for people after stroke who no longer receive physical therapist directed rehabilitation.
CASE DESCRIPTIONS: Case reports about 10 participants (ages 30-72, 5 men/women) with moderate to severe hemiparesis (2-14 years post stroke) who have received between 2-10 annual intensive intervention session will be presented. The intervention is provided by student physical therapists under the direction of physical therapists and includes repetitive, task specific training for the upper extremity, balance and gait training.
OUTCOMES: Case reports will include gains made at the end of each annual 5-day intervention and annual baseline values to identify those who sustained, improved, or declined between each intervention bout. Outcome measures include measures of upper and lower extremity function (i.e. Fugl Meyer and Wolf Motor Function Test), balance (i.e. Berg Balance Test and Functional Gait Assessment) and gait (i.e. 10 Meter Walk Test, Timed Up and Go Test, and 6 Minute Walk Test). The overall health, quality of life and annual healthcare related costs of these patients will be presented. To evaluate the overall value to the health care system, we will compare functional status, health, and healthcare costs of the individuals to published national averages of persons with comparable impairment after CVA.
DISCUSSION: We will present evidence that will demonstrate the value of the investment in periodic intensive rehabilitation for individuals with hemiparesis. We will demonstrate that under the direction of a physical therapist, individuals with moderate to severe chronic hemiparesis who participate in an intensive whole body intervention on an annual basis have a higher quality of life, fewer secondary complications requiring medical intervention, and lower over-all healthcare costs as compared to those who no longer participate in physical therapist directed rehabilitation. This approach has the potential to achieve the dimensions of the Triple Aim of Healthcare (www.ihi.org) by enhancing quality of life, ensuring long-term health, and reducing overall life-time costs to the healthcare system.
Citation:
Carter, Valerie A, PT, DPT, NCS; Wing, Kay , PT, DPT, NCS, GCS; Gatewood, Kim K, PT, DPT, NCS; Williams, Petra S, PT, PhD, NCS. The value of physical therapist directed intensive whole body rehabilitation for patients with moderate to severe hemiparesis after stroke: a retrospective case series.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/101_carter-et-al/