Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

Discharge Assessment Tool in Stroke and Elderly Patients: A Systematic Review

뇌졸중 및 노인 환자의 퇴원 평가도구에 대한 체계적 고찰

  • Hwang, Na-Kyoung (Department of Occupational Therapy, Seoul North Municipal Hospital) ;
  • Yoo, Eun-Young (Department of Occupational Therapy, College of Health Science, Yonsei University)
  • 황나경 (서울특별시 북부병원) ;
  • 유은영 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2019.12.10
  • Accepted : 2019.12.27
  • Published : 2020.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The aim of this systematic review is to analyze the assessment items and tools used for the discharge of stroke and elderly patients and to help select appropriate assessment tools for discharge planning. Methods : The studies included in this review were collected from the PubMed, Medline Complete (EBSCOhost), and Scopus databases from January 2009 to December 2018. A total 22 studies were selected. The research types, the areas and sub-areas of assessment, as well as the assessment tools according to the areas were analyzed. Results : Descriptive research (59.2%) was the most frequent type of research. The 12 main areas of assessment were medical condition, activities of daily living, swallowing function, sensation, mobility, cognition and perception, communication, emotion, home environment, patient knowledge and readiness for discharge, social support, and well-being. Among the assessment tools, the most frequently used tools were Bathel Index; Functional Independence Measure, to assess activities of daily living; Short-Form Health Survey, to assess well-being, and Timed Up and Go test, to assess mobility. Conclusion : This study will help select the assessment areas and tools to be considered at discharge of stroke patients and serve a basis for the development of comprehensive assessment tools for discharge planning.

목적 : 본 연구는 뇌졸중 환자와 노인 환자를 대상으로 퇴원 시기에 이루어지는 평가도구에 대한 체계적 문헌고찰을 통해 평가 항목과 평가도구들을 분석하여 효율적인 퇴원계획을 위한 기초자료를 제공하고자 한다. 연구방법 : 문헌 선정은 PubMed, Medline Complete(EBSCOhost), Scopus를 사용하여 2009년 1월부터 2018년 12월까지의 온라인 데이터에 등록된 연구를 대상으로 최종 22편의 연구를 선정하였고, 연구 설계 및 퇴원 시 주요 평가영역, 하위영역, 평가도구들을 분석하였다. 결과 : 선택된 연구들의 연구 설계 형태는 기술적 연구가 13편(59.2%)으로 가장 많았다. 퇴원 시 평가 영역은 의학적 상태, 일상생활활동, 삼킴 기능, 감각, 이동성, 인지·지각, 의사소통, 감정상태, 가정환경, 환자의 지식과 퇴원을 위한 준비, 사회적지지, 안녕감 등 12개 영역으로 나타났다. 평가 영역에 따라 사용된 평가도구를 분석한 결과, 가장 높은 빈도의 사용을 보이는 평가도구는 일상생활활동을 평가하는 Barthel Index, Functional Independence Measure, 안녕감을 평가하는 Short Form Health Survey, 이동성을 평가하는 Timed Up and Go test 등으로 나타났다. 결론 : 본 연구를 통해 뇌졸중, 노인 환자의 퇴원 시 이루어지는 다양한 평가 영역과 평가도구의 사용과 제한적이나 여러 영역을 포괄하는 평가도구들을 확인할 수 있었다. 이는 뇌졸중 환자의 퇴원 시 고려되는 평가 영역과 효과적인 평가도구의 선택을 돕고 적절한 퇴원계획 중재와 제안을 위한 포괄적인 평가도구의 개발의 기초자료가 될 것이다.

Keywords

References

  1. Becker, D., Sharma, P., Kilgore, M., & Yurgin, N. (2015). Real-world costs for first and recurrent events of myocardial infarction and stroke in the elderly medicare population. Journal of Clinical Lipidology, 9(3), 454. doi:10.1016/j.jacl.2015.03.072
  2. Bodilsen, A. C., Klausen, H. H., Petersen, J., Beyer, N., Andersen, O., Jorgensen, L. M., & Bandholm, T. (2016). Prediction of mobility limitations after hospitalization in older medical patients by simple measures of physical performance obtained at admission to the emergency department. PLoS One, 11(5), 1-11. doi:10.1371journal.pone.0154350
  3. Bowling, A., & Iliffe, S. (2011). Psychological approach to successful ageing predicts future quality of life in older adults. Health and Quality of Life Outcomes, 9(1), 1-13. doi:10.1186/1477-7525-9-13
  4. Case-Smith, J., & Powell, C. A. (2008). Research literature in occupation therapy, 2001-2005. American Journal of Occupational Therapy, 62(4), 480-486. doi:10.5014/ajot.62.4.480
  5. Cruz, L. C., Fine, J. S., & Nori, S. (2017). Barriers to discharge from inpatient rehabilitation: A teamwork approach. International Journal of Health Care Quality Assurance, 30(2), 137-147. doi:10.1108/IJHCQA-07-2016-0102
  6. Department of Human Services, Victoria. (1998). Effective discharge strategy background paper: A framework for effective discharge. Retrieved from http://www.health.vic.gov.au/archive/archive2008/discharge/paper
  7. Gonzalez-Fernandez, M., Ottenstein, L., Atanelov, L., & Christian, A. B. (2013). Dysphagia after stroke: An overview. Current Physical Medicine and Rehabilitation Reports, 1(3), 187-196. doi:10.1007/s40141-013-0017-y
  8. Harris, S., James, E., & Snow, P. (2008). Predischarge occupational therapy home assessment visits: Towards an evidence base. Australian Occupational Therapy Journal, 55(2), 85-95. doi:10.1111/j.1440-1630.2007.00684.x
  9. Hsueh, I. P., Wang, C. H,, Liou, T. H., Lin, C. H., & Hsieh, C. L. (2012). Test- retest reliability and validity of the comprehensive activities of daily living measure in patients with stroke. Journal of Rehabilitation Medicine, 44(8), 63-41 . doi:10.2340/16501977-1004.
  10. Johnston, K., Barras, S., & Grimmer-Somers, K. (2010). Relationship between pre discharge occupational therapy home assessment and prevalence of post discharge falls. Journal of Evaluation in Clinical Practice, 16(6), 1333-1339. doi:10.1111/j.1365-2753.2009.01339.x
  11. Khan, A., Carmona, R., & Traube, M. (2014). Dysphagia in the elderly. Clinics in Geriatric Medicine, 30(1), 43-53. doi:10.1016/j.cger.2013.10.009
  12. Kim, J. S., Choi-Kwon, S., Kwon, S. U., Lee, H. J., Park, K. A., & Seo, Y. S. (2005). Factors affecting the quality of life after ischemic stroke: Young versus old patients. Journal of Clinical Neurology, 1(1), 59-68. doi:10.3988/jcn.2005.1.1.59
  13. Korea Institute for Health and Social Affairs. (2017). National survey of persons with disabilities 2017. Retrieved from https://www.data.go.kr/data/15044551/fileData.do
  14. Miller, J. F., Piacentine, L. B., & Weiss, M. (2008). Coping difficulties after hospitalization. Clinical Nursing Research, 17(4), 278-296. doi:10.1177/1054473808325226
  15. Mistiaen, P., Duijnhouwer, E., & Ettema, T. (2000). The construction of a research model on post-discharge problems based on a review of the literature 1990-1995. Social Work in Health Care, 29(4), 33-68. doi:10.1300/J010v29n04_03
  16. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), 1-6. doi:10.1371/journal.pmed.1000097
  17. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., & Turner, M. B. (2016). Heart disease and stroke statistics-2016 update: A report from the American heart association. Circulation, 133(4), 310-314. doi:10.1161/CIR.0000000000000350
  18. Ostir, G. V., Berges, I. M., Kuo, Y. F., Goodwin, J. S., Fisher, S. R., & Guralnik, J. M. (2013). Mobility activity and its value as a prognostic indicator of survival in hospitalized older adults. Journal of the American Geriatrics Society, 61(4), 551-557. doi:10.1111/jgs. 12170
  19. Samsa, G. P., Bian, J., Lipscomb, J., & Matchar, D. B. (1999). Epidemiology of recurrent cerebral infarction. Stroke, 30(2), 338-349. doi:10.1161/01.STR.30.2.338
  20. Schneider, M. A., & Howard, K. A. (2017). Using technology to enhance discharge teaching and improve coping for patients after stroke. Journal of Neuroscience Nursing. 49(3), 152-156. doi:10.1097/jnn.0000000000000275
  21. Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L. (2013). Discharge planning from hospital to home. Cochrane Database of Systematic Reviews, (1), CD000313. doi:org/10.1002/14651858.CD000313.pub4
  22. 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
  23. Taylor, R., Kurytnik, L., & Pain, K. (2007). Discharge planning for older adults: The added value of occupational therapy home visits. Occupational Therapy Now, 9(5), 18-20.
  24. Wong, E. L., Cheung, A. W., Leung, M. C., Yam, C. H., Chan, F. W., Wong, F. Y., & Yeoh, E. K. (2011). Unplanned readmission rates, length of hospital stay, mortality, and medical costs of ten common medical conditions: A retrospective analysis of Hong Kong hospital data. BMC Health Services Research, 11, 1-11. doi:10.1186/1472-6963-11-149
  25. Yam, C. H., Wong, E. L., Cheung, A. W., Chan, F. W., Wong, F. Y., & Yeoh, E. K. (2012). Framework and components for effective discharge planning system: A delphi methodology. BMC Health Services Research, 12, 1-16. doi:10.1186/1472-6963-12-396