期刊
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
卷 103, 期 1, 页码 1-+出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2021.08.013
关键词
Motivation; Outpatients; Patient compliance; Rehabilitation; Stroke rehabilitation; Transportation
资金
- National Medical Research Council of Singapore under its Health Services Research Competitive Research Grant
Providing free transportation and prescribed stroke rehabilitation sessions can increase the uptake of outpatient rehabilitation services among stroke patients. The average number of rehabilitation sessions attended was significantly higher in the intervention arms compared to the control arm, indicating the effectiveness of incentivizing survivors of stroke to take up rehabilitation services.
Y Objective: To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense). Design: Three-arm randomized controlled trial. Setting: Stroke units of 2 Singapore tertiary hospitals. Participants: Singaporeans or permanent residents 21 years or older who were diagnosed as having stroke and were discharged home with physician's recommendation to continue outpatient rehabilitation (N=266). Interventions: A Transportation Incentives arm (T), which provides free transportation services, a Transportation & Sessions Incentives arm (T&S), offering free transportation and prescribed stroke rehabilitation sessions, and a control arm, Education (E), consisting of a stroke rehabilitation educational program. Main Outcome Measures: The primary study outcome was uptake of outpatient rehabilitation services (ORS) among patients poststroke and key predefined secondary outcomes being number of sessions attended and adherence to prescribed sessions. Results: Uptake rate of ORS was 73.0% for E (confidence interval [CI], 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). Differences of T and T&S vs E were not statistically significant (P=.22 and P=.10, respectively). However, average number of rehabilitation sessions attended were significantly higher in both intervention arms: 5.50 +/- 7.65 for T and 7.51 +/- 9.52 for T&S vs 3.26 +/- 4.22 for control arm (E) (T vs E: P=.017; T&S vs E: P<.001). Kaplan-Meier analysis indicated that persistence was higher for T&S compared with E (P=.029). Conclusions: This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing survivors of stroke to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services. (C) 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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