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PROBLEMS OF OUTCOMES CHOICE FOR THE ASSESSMENT OF REHABILITATION PROGRAMS EFFICIENCY IN PATIENTS AFTER STROKE AND CRANIOCEREBRAL INJURY

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Abstract

this article considers the appropriateness of surrogate points and endpoints utilization as evaluation criteria for rehabilitation programs efficiency in patients after stroke, craniocerebral injury or other CNS diseases (e.g. tumors, neuroinfections etc.) in Russian Federation. The purpose of this study is to evaluate surrogate and final outcomes of neurorehabilitation program in patients after stroke and craniocerebral injury. Materials and methods. The study was carried out using data provided by the Center of speech pathology and neurorehabilitation. A notion of Social status recovery was selected as an economically significant surrogate outcome which was evaluated by physicians at the end of the rehabilitation course. A notion of Disability conferred by the Federal State Institutions of Disability Evaluation was selected as an economically significant final outcome. Surrogate and final outcomes comparison was performed based on the regulatory materials. Results. Surrogate outcomes evaluation revealed that at the end of rehabilitation course most patients (86.64%) reached the level of social and living needs, i.e. they have an ability to live and to take care for themselves without assistance. Final outcomes evaluation revealed that proportion of patient without disability decreased by 4-fold between the first and second visits and that total changes in disability degree by the time of the last visit were significantly smaller in comparison with the second patient's visit to the Center. Comparison of surrogate and final outcomes revealed significant discrepancy between the patient's status characteristics. Thus, in the disability group I only 7.66% of patients were actually unable to perform activities of daily living without assistance, while 90.46% of patients were able to live without assistance, that corresponds to the disability group II. Conclusion. Established degree of disability often does not correspond to the actual patient's state. The analysis based on the disability group changes is not sensitive enough for the evaluation of rehabilitation programs efficacy. Therefore, the use of indirect signs of economically significant recovery seems to be more appropriate for the efficacy evaluation of such technology. 

About the Authors

V. S. Dombrovskiy
The Russian Presidential Academy of National Economy and Public Administration
Russian Federation


V. V. Omelyanovskiy
The Russian Presidential Academy of National Economy and Public Administration
Russian Federation


References

1. Resolution of the Government of the Russian Federation «On the procedure and conditions for recognizing a person disabled» February 20, 2006 N 95 (as amended. RF Government Decree of 30.12.2009 N 1121) [Postanovlenie Pravitel'stva Rossiiskoi Federatsii «O poryadke i usloviyakh priznaniya litsa invalidom» ot 20 fevralya 2006 g. N 95 (v red. Postanovleniya Pravitel'stva RF ot 30.12.2009g N 1121)].

2. Order of the Ministry of Health and Social Development of the Russian Federation «On Approving the classifications and criteria used in the implementation of medical and social expertise of citizens by federal government agencies medical and social expertise» from 23.12.2009 N 1013n. [Prikaz Ministerstva zdravookhraneniya i sotsial'nogo razvitiya Rossiiskoi Federatsii «Ob utverzhdenii klassifikatsii i kriteriev, ispol'zuemykh pri osushchestvlenii medikosotsial'noi ekspertizy grazhdan federal'nymi gosudarstvennymi uchrezhdeniyami mediko-sotsial'noi ekspertizy» ot 23.12.2009 g. N 1013n.]


For citation:


Dombrovskiy V.S., Omelyanovskiy V.V. PROBLEMS OF OUTCOMES CHOICE FOR THE ASSESSMENT OF REHABILITATION PROGRAMS EFFICIENCY IN PATIENTS AFTER STROKE AND CRANIOCEREBRAL INJURY. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2014;7(3):20-25. (In Russ.)

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)