The Development of a Physical Therapy Rehabilitation Model to Improve Activities of Daily Living Among Stroke Patients in The Intermediate Care Ward of Mahasarakham Hospital

Abstract

This action research aimed to develop and determine the results of the physical therapy rehabilitation model for improving activities of daily living (ADL) among stroke patients in the intermediate care ward of Mahasarakham Hospital. The research process was divided into three phases: 1) preparation phases 2) implementation phases and 3) evaluation phases. There were four steps in the implementation phase utilizing the PAOR circuit: 1) planning 2) action 3) observation and 4) reflection. The research participants comprised nine physical therapists, 12 interdisciplinary teams, 60 post-stroke patients, and their relatives or caregivers. The research period was July 2023 - July 2024. The instruments consisted of an interview form for stroke patients and their relatives, the Barthel Index Score (BIS) of stroke patients, the Modified Rankin Scale (MRS) of stroke patients, knowledge of stroke disease, knowledge and skills assessment forms regarding physical therapy rehabilitation of caregivers and satisfaction questionnaires. Data was analyzed using percentages, means and the Wilcoxon Signed-Rank Test, while qualitative data was analyzed using content analysis.

The results of the study on the development of a new model of physical therapy rehabilitation under the context of Mahasarakham Hospital “PT-MSKH Plus model” included: 1) consultation from a doctor 2) initial assessment 3) goal setting with the participation of patients and relatives 4) physical therapy rehabilitation in the rehabilitation medical ward 5) evaluation of physical therapy rehabilitation 6) discharge planning with a multidisciplinary team and 7) referring rehabilitation information to a multidisciplinary team in the community. The results indicated that BIS scores of stroke patients improved significantly (p < 0.001), knowledge of stroke disease, knowledge and skills in physical therapy rehabilitation improved significantly (p<0.001). The MRS had decreased significantly (p<0.001), the satisfaction of patients and caregivers, relatives and the multidisciplinary team of a Physical Therapy Rehabilitation Model of stroke patients was at the highest level respectively. Moreover, this study developed a set of manuals, “To Get Better Sitting Walking, and Living a Happier Life through Rehabilitation,” for multidisciplinary teams’ patients and their relatives.

Conclusion: This model offered benefits in the intermediate phase of stroke rehabilitation. Patients receiving the model recovered better from activities of daily living. Therefore, the multidisciplinary healthcare team should apply and expand the model for physical therapy rehabilitation in other hospitals.