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Functionele uitkomsten in het eerste jaar na een aneurysmatische subarachnoïdale bloeding:een prospectief cohortonderzoek

(2012) Braaksma, R. (Rudwina)

Background and purpose:
After a subarachnoid haemorrhage (SAH) patients experience all kinds of problems, relatively few research however has been done concerning the functional situation. Aim of this study was to describe the subjective functional situation of patients during the first year after occurrence of an aneurysmal SAH.
Materials and methods:
A prospective cohort study within an aftercare project was set up. Patients who had been hospitalized in the Isala clinics because of a SAH between February 2009 and December 2010 were included. Primary outcome measure was the Frenchay Activities Index (FAI). Secondary outcome measures were the Barthel Index (BI), Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), Caregiver Strain Index (CGSI) and a work questionnaire. Questionnaires were applied after 3, 6 and 12 months. At 3-months follow-up patients were asked to complete the FAI with the premorbid situation in mind. Within the scope of the aftercare project, attention was paid to the functional situation of patients who had in first instance been discharged home without rehabilitation treatment.
Results:
126 patients were hospitalized, from whom 57 patients participated in the aftercare project. Data of 36 patients was suitable for analysis. The premorbid FAI score, the score after 6 months and the score after 12 months were respectively 33.6 (95% CI 32-35.3), 28.9 (95% CI 26.5-31.4) and 31.2 (95% CI 29.1-33.2). Differences between the premorbid situation and the follow-up assessments at 6 and 12 months were statistically significant, but were not clinically relevant. BI, CFQ, HADS and CGSI did not show any significant change in time. At 12-months follow-up 9 of 26 previously working patients had fully resumed their occupation. Of the 22 patients who had been discharged home without rehabilitation treatment, 5 were referred for an out-patient rehabilitation treatment during follow-up. Most important reasons for referral were cognitive problems and problems in work resumption.
Conclusion and level of evidence:
Although no clinically relevant changes were found, study results indicate a worsening of the functional situation as a result of a SAH, followed by improvement between 6 and 12 months. Questionnaire results did not suggest cognitive or psychological complaints, however cognitive problems turned out to be an important reason for referral for rehabilitation treatment in a later stadium. This study confirms the importance of assessment of SAH patients by a rehabilitation physician in order to signal problems and start appropriate rehabilitation treatment if necessary. Level of evidence is C1.





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