Assistenza Domiciliare Riabilitativa Intensiva: Presentazione di un protocollo operativa e risultati preliminari

Background: Home Rehabilitation (HR) is presented in the National Guidelines for Rehabilitation as an intervention providing continuing care in the hospital-community rehabilitation pathway. Its aims include reducing inappropriate hospitalization; early home return is particularly important for the elderly patient. Objectives: Preliminary evalutation of an Operative Protocol of post-acute HR performed by the Don Gnocchi Foundation (DGF) inspired to the Quality Management Guidelines (ISO9001) in agreement with the Local Health Agency 10, Florence. Materials and Methods: Persons in dismission from hospital with a diagnosis of recent orthopaedic surgery, stroke, immobilization syndrome, clinically stable, with no need for nursing assistance and good family and social support. The Rehabilitation Plan and patient's care start within 3 working days. A structured fuctional evalution derived from the mobility component of the Functional Independence Measure is administred at the beginning and at the end of treatment. Results: In December 2003-July 2004 18 patients were enrolled (7 men, mean age = 67,2; 12 women, mean age = 74.8). Diagnoses were: Recent stroke (2), recent hip or knee surgery (14), immobility (2). At the end of treatment all patients had improved their mobility, and 12 were dismissed with the top score for each mobility item. The average cost for each treatment was 1,188.18 euro, which can be compared to the cost of 4,080 euro for a standard post-acute orthopaedic in-patient Rehabilitation. Conclusions: Preliminary data show that the HR Protocol presented meets the needs of post-acute rehabilitation promptly and efficiently at a very low cost.