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Family-led rehab after stroke ineffective

PTI | New Delhi |

Family-led rehabilitation for stroke patients is ineffective, according to a study which highlights the need for investment in professional stroke facilities in low and middle-income countries.

The randomised controlled trial, during which 1,250 patients in India were followed over a period of six months (between January 2014-February 2016), was carried out by George Institute for Global Health.

The research published in the Lancet yesterday stated there was no reduction in disability in patients on the trial, compared to those who received no extra care.

Lead author Professor Richard Lyndell of The George Institute for Global Health and the University of Sydney, said the results were surprising.

“We had expected to see a marked improvement in recovery of people who received this extra care delivered by their own trained family members, in their own homes.

“We found that despite extensive training in hospital and during follow up visits in the home, there was no difference in the degree of recovery or quality of life of people who received this extra treatment,” Lindy said.

He said the results suggest that effective rehabilitation may need to be provided by professionals who have undergone years of training and are specialists in their own field, which may impose major challenges to poor communities with limited financial resources.

As part of the study the George Institute researchers, both in India and Australia, along with international and Indian stroke experts followed 1,250 patients.

Half of them were provided with access to professionals, such as physiotherapists who taught the family techniques such as mobility training and communication practice. Each patient was also visited at their home to ensure that rehabilitation was carried out correctly by their caregiver.

It is estimated that around 1.6 million people have a stroke in India each year, yet the vast majority receive no formal rehabilitation.

“In India, there are only 35 stroke units and most are in cities. In response to the rising rates of stroke there needs to be much greater investment in facilities for such patients and measures to protect them from the potentially prohibitive costs of treatment,” Lindley added.

It had been hoped the family-led care, also known as task shifting (the training of non-healthcare workers to perform tasks traditionally undertaken by the multidisciplinary team), would help address the limited healthcare access for those with stroke in low and middle-income countries.

Community rehabilitation is also a priority of the World Health Organisation.

The disappointing results of the trial provide important new evidence that task shifting a complex intervention such as rehabilitation may not be effective, said Professor GV Murthy of the Indian Institute of Public Health, the co-chair of the study.

“We need more rigorous examinations of such family and community-led programs before they become common place,” Murthy said.

The project was led by The George Institute for Global Health, Sydney, Australia, and funded by the National Health and Medical Research Council of Australia.