COST-EFFECTIVENESS ANALYSIS OF EARLY MEDICAL REHABILITATION OF PATIENTS WITH CEREBRAL STROKE
Abstract and keywords
Abstract (English):
Carrying out resuscitation procedures in the intensive care unit (ICU) aimed at maintaining and restoring the patient’s vital functions, the use of specialized resuscitation equipment and bed rest simultaneously lead to aggravation of the patient’s condition. The consequences of being in the ICU may also include the development of the post-intensive care syndrome (PIT syndrome), the prevention of which is the main goal of early rehabilitation with the participation of the multidisciplinary rehabilitation team of specialists (MDRT) led by a physical and rehabilitation medicine physician. Specialized medical rehabilitation carried out by MDRT is extremely benefi cial for all neurological conditions, resulting in substantial savings in ongoing care costs, especially for ICU patients. The foreign and domestic research experience indicates a reduction in healthcare costs when introducing early rehabilitation in the ICU by reducing the duration of the patient’s stay in the expensive round-the-clock bed and lowering the patient’s home care costs or continuing rehabilitation activities at the second and third stages, as well as saving precious time for eff ective recovery of the developed functional defi cits. It may seem that rehabilitation in the ICU with the participation of MDRT is more expensive than the work of one department doctor and a nurse. However, this article provides evidence of the economic effi ciency of the MDRT work on the analysis of the results of the pilot project “Development of the Medical Rehabilitation System in the Russian Federation”, as well as the analysis of clinical cases of the Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia. So, in the absence of early rehabilitation in the ICU, the patient’s stay is delayed and the number of re-hospitalizations to the unit increases. Thus, the results of early medical rehabilitation will have a direct impact on reducing the costs associated with bed-days reducing, providing patient’s care, changing the working life of relatives, pensions of patients and their caregivers.

Keywords:
early rehabilitation, ICU, immobilization syndrome, PIT syndrome, early rehabilitation in intensive care, multidisciplinary team, economic effi ciency, rehabilitation, stroke
Text
Text (PDF): Read Download
References

1. Adler J., Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary Physical Therapy Journal. 2012; 23(1): 5-13.

2. Belkin A. A. Sindrom posledstviy intensivnoy terapii (PIT-sindrom). Vestnik intensivnoy terapii imeni A. I. Saltanova. 2018; (2): 12-23. https://doi.org/10.21320/1818-474X-2018-2-12-23

3. Musalatov H.A., Elizarov M. N., Nasridinov M. A. Lechenie prolezhney oblasti krestca u bol'nyh s povrezhdeniem pozvonochnika i spinnogo mozga. Medicinskaya pomosch'. 2002: 3 c.

4. Fife C., Otto G., Capsuto E. G., Brandt K., Lyssy K. et al. Incidence of pressure ulcers in a neurologic intensive care unit. Critical Care Medicine. 2001; 29(2): 283-290. https://doi.org/10.1097/00003246-200102000-00011

5. Hermans G., Van den Berghe G. Clinical review: intensive care unit acquired weakness. Critical Care. 2015; 19(1): 1-9. https://doi.org/10.1186/s13054-015-0993-7

6. De Jonghe B., Sharshar T., Lefaucheur J.P., Authier F.J. et al. Groupe de Réfl exion et d’Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002; 288(22): 2859-67. https://doi.org/10.1001/jama.288.22.2859

7. Desai S.V., Law T.J., Needham D. M. Long-term complications of critical care. Critical Care Medicine. 2011; 39(2): 371-9. https://doi.org/10.1097/CCM.0b013e3181fd66e5

8. Stevens R.D., Dowdy D. W., Michaels R. K., Mendez- Tellez P.A. et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. In- tensive Care Medicine. 2007; 33(11):1876-91. https://doi.org/10.1007/s00134-007-0772-2

9. Parry S.M., El- Ansary D., Cartwright M. S., Sarwal A. et al. Ultrasonography in the intensive care setting can be used to detect chang- es in the quality and quantity of muscle and is related to muscle strength and function. Journal Critical Care. 2015; 30(5): 1151.e9-14. https://doi.org/10.1016/j.jcrc.2015.05.024

10. Puthucheary Z.A., Rawal J., McPhail M., Connolly B. et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013; 310(15): 1591-600. https://doi.org/10.1001/jama.2013.278481

11. Hermans G., Mechelen H., Clerckx B., Vanhullebusch T. et al. Acute outcomes and 1-year mortality of intensive care unitacquired weakness: a cohort study and propensity-matched analysis. American Journal of Respiratory and Critical Care Medicine. 2014; 190(4): 410-20. https://doi.org/10.1164/rccm.201312-2257OC

12. Dos Santos C., Hussain S. N., Mathur S., Picard M. et al. MEND ICU Group; RECOVER Program Investigators; Canadian Critical Care Translational Biology Group. Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study. American Journal of Respiratory and Critical Care Medicine. 2016; 194(7): 821-830. https://doi.org/10.1164/rccm.201512-2344OC

13. Needham D.M., Davidson J., Cohen H., Hopkins R. O. et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Critical Care Medicine. 2012; 40(2): 502-9. https://doi.org/10.1097/CCM.0b013e318232da75

14. Cavallazzi R., Saad M., Marik P. E. Delirium in the ICU: an overview. Annals of Intensive Care. 2012; 2(1): 49 p. https://doi.org/10.1186/2110-5820-2-49

15. Herridge M., Cameron J. I. Disability after critical illness. New England Journal of Medicine. 2013; 369(14): 1367-9. https://doi.org/10.1056/NEJMe1309482

16. Calvo- Ayala E., Khan B. A., Farber M. O., Ely E. W. et al. Interventions to improve the physical function of ICU survivors: a systematic review. Chest. 2013; 144(5): 1469-1480. https://doi.org/10.1378/chest.13-0779

17. Brodsky M.B., González- Fernández M., Mendez- Tellez P.A., Shanholtz C. et al. Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury. Annals of the American Thoracic Society. 2014; 11(10): 1545-52. https://doi.org/10.1513/AnnalsATS.201406-274OC

Login or Create
* Forgot password?