Анализ ключевых компонентов реабилитационного диагноза у пациентов с инсультом в острейшую фазу

Introduction. There are key problems that limit patients’ functioning in the period after insult. The content of these problems determines the structure of multidisciplinary team.The objective of the study was to describe key problems that limited patients’ functioning in the period after insult and determine the structure of multidisciplinary team for resolving these problems efficiently.Material and methods. The study was observational. The sample size was 81 patients. Inclusion criteria: acute phase of post ischemic or hemorrhagic stroke (0–14 days after onset), mRs score 2 and more at admission to the hospital, the age over 18 years. Exclusion criteria: patients with transient ischemic attack, subarachnoid haemorrhage, Glasgow coma scale 2 and more at admission to the hospital. All patients – research participants received medical care in according to clinical guidelines, and multidisciplinary rehabilitation. In the course of rehabilitation, the first and second key problems that limited patients’ functioning in the period after insult were dedicated in each patient. We also investigated these problems and explored, which specialists must have been included in the structure of multidisciplinary team.Results. The key problems were non-medical in 24 % cases, poor exercise capacity were presented in 27 % cases, environment issues – 6 % cases, swallowing and speech disorders – 17 %, nursery problems – 4 %. The next specialists were needed to resolve the key problems: psychologist – 38 % cases, physical therapist– 69 % cases, occupational therapist – 28 % cases, neurologist – 27 % cases, physical medicine and rehabilitation physician – 27 % cases.Conclusion. Medical (rehabilitation physician, specialist, nurse) and non-medical specialists (occupational therapist, physical therapist, psychologist, logopaedist, etc.) must have been included in multidisciplinary team.Введение. У пациентов с инсультом в реабилитационном периоде обнаруживаются ключевые проблемы, ограничивающие функционирование. Характер ключевых проблем определяет потребность определенных специалистов в составе мультидисциплинарной бригады (МДБ).Цель исследования. Описать ключевые проблемы, ограничивающие функционирование пациентов с инсультом и определить какие специалисты должны входить в состав МДБ.Материалы и методы. Исследование наблюдательное. Размер выборки 81 человек. В выборку включены пациенты в острейшем периоде ишемического или геморрагического инсульта, с оценкой по модифицированной шкале Рэнкина 2 и более балла при поступлении в стационар, возрастом старше 18 лет. В выборку намерено не включались пациенты с изолированной транзиторной ишемической атакой, изолированным субарахноидальным кровоизлиянием, с уровнем сознания при поступлении кома 2 и более. Пациентам – участникам исследования оказана медицинская помощь в соответствии с имеющимися рекомендациями, проведена мультидисциплинарная реабилитация. В ходе реабилитации у каждого пациента выделены первая и вторая ключевая проблемы, ограничивающие функционирование.Результаты. Ключевые проблемы носили немедицинский характер в 24% случаев, снижение толерантности к физической нагрузке – 27% случаев, проблемы со средой – 6% случаев, нарушения глотания и речи – 17% случаев, проблемы сестринского характера – 4% случаев. Для решения ключевых проблем требовалось участие психолога в 38% случаев, физического терапевта – в 69% случаев, эрготерапевта – в 28% случаев, невролога – в 27% случаев, врача-реабилитолога – в 27% случаев.Заключение. В состав мультидисциплинарной бригады должны входить специалисты медицинского (врач-реабилитолог, профильный специалист, медицинская сестра) и немедицинского профиля (эрготерапевт, физический терапевт, психолог, логопед, и др.)

Analysis of key components in the rehabilitation diagnosis of acute stroke patients

Introduction. There are key problems that limit patients’ functioning in the period after insult. The content of these problems determines the structure of multidisciplinary team.The objective of the study was to describe key problems that limited patients’ functioning in the period after insult and determine the structure of multidisciplinary team for resolving these problems efficiently.Material and methods. The study was observational. The sample size was 81 patients. Inclusion criteria: acute phase of post ischemic or hemorrhagic stroke (0–14 days after onset), mRs score 2 and more at admission to the hospital, the age over 18 years. Exclusion criteria: patients with transient ischemic attack, subarachnoid haemorrhage, Glasgow coma scale 2 and more at admission to the hospital. All patients – research participants received medical care in according to clinical guidelines, and multidisciplinary rehabilitation. In the course of rehabilitation, the first and second key problems that limited patients’ functioning in the period after insult were dedicated in each patient. We also investigated these problems and explored, which specialists must have been included in the structure of multidisciplinary team.Results. The key problems were non-medical in 24 % cases, poor exercise capacity were presented in 27 % cases, environment issues – 6 % cases, swallowing and speech disorders – 17 %, nursery problems – 4 %. The next specialists were needed to resolve the key problems: psychologist – 38 % cases, physical therapist– 69 % cases, occupational therapist – 28 % cases, neurologist – 27 % cases, physical medicine and rehabilitation physician – 27 % cases.Conclusion. Medical (rehabilitation physician, specialist, nurse) and non-medical specialists (occupational therapist, physical therapist, psychologist, logopaedist, etc.) must have been included in multidisciplinary team