Timing, INtensity, and Duration of Rehabilitation for Hip and Stroke Frature

摘要

A workshop on rehabilitation for stroke and hip fracture was held August 4 by the National Center for Medical Rehabilitation Research at the NIH. The workshop focused upon key clinical and methodological issues for study: timing, intensity, and duration of rehabilitation. Stroke and hip fracture were included together because these two diagnoses are responsible for the majority of inpatient rehabilitation bed days (and expense) for the elderly. Current medical practice has been heavily influenced by reimbursement rules, with comparatively little empirical research on optimal treatment schedules. Serious methodological and logistical issues confront investigators who seek to address this issue. The purpose of the workshop was bring together rehabilitation clinician-investigators, epidemiologists, and policy analysts to discuss the steps necessary to carry out clinical trials that determine optimal therapy schedules. Much common ground was found between the investigations necessary and the problems faced by investigators in determining optimal therapy schedules for patients with hip fracture and stroke: key issues such as patient selection, trial design, ethics of assignment, characterization of therapies, measurement of outcomes and financing of trials. In contrast, the problem faced by health policy makers is to allocate resources among patients fairly.