Prosthetic usage among the Thai lower limb amputees.

Objective: To study the percentage of prosthetic usage and factors associated with prosthetic usage among lower limb amputees in Thailand. Methods: The postal survey with a questionnaire was sent to 1,300 amputees who received lower limb prostheses between 2001 and 2005. The participants were divided into two groups, namely, the prosthetic usage and prosthetic non-usage groups. A Chi-Square and an Independent Sample T test were used to compare the differences between the two groups. The multiple variables analysis by stepwise logistic regression was used to determine the associated factors. Results: Three hundred and nineteen questionnaires were completed among three hundred and twenty one returned questionnaires. The percentage of amputees who used a prosthesis over 5 hours per day was 82.1%. Demographically, the prosthetic usage group had less diabetes mellitus (p =0.010), were younger at the time of amputation (p <0.001), and had a currently employed status (p <0.001) than the non-prosthetic usage group. (You have not stated what you are comparing this group to!) In Amputation related factors the transtibial amputees were more likely to use prostheses (p <0.001). The factors associated with prosthetic usage were experiencing satisfactory to good wearing comfort (OR 12.83), a transtibial level of amputation (OR 9.65), having a currently employed status (OR 5.12), undergoing particular etiologies of amputation such as congenital problem or blast injury (OR 2.78) and being young at time of amputation (OR 0.95), respectively. Conclusion: The percentage of prosthetic usage among the Thai lower limb amputees was 82.1%. The factors associated with the prosthetic usage were wearing comfort, level of amputation, having a currently employed status and being of younger age at the time of amputation.

Anxiety and depressive symptoms after stroke in 9 rehabilitation centers.

OBJECTIVE: Determine the occurrence of anxiety and depressive symptoms in rehabilitation phase and identify the associated factors that include impact on functional outcome and quality of life in stroke patients. DESIGN: Prospective analytical study. MATERIAL AND METHOD: Two hundred fifty one stroke patients from nine rehabilitation centers admitted between March and December 2006 were enrolled into the present study. Anxiety and depressive symptoms were evaluated in stroke patients using the Hospital Anxiety and Depressive Scales (HADS) twice, on admission and at discharge to rehabilitation program. Factors associated with anxiety and depressive symptoms were identified using univariate and multiple logistic regression analyses. Functional ability and quality of life using Barthel ADL Index (BI) and WHOQOL-BREF questionnaires respectively were recorded and analyzed. RESULTS: Two hundred fifty one patients were assessed for anxiety and depressive symptoms using HADS. It was found that 25.5% of the patients suffered from anxiety symptoms, 37.8% from depressive symptoms, and 17.5% from both. Anxiety symptoms were associated with depressive symptoms (OR 5.49, 95%CI 2.89-10.43) and negatively associated with dyslipidemia (OR 0.48, 95%CI 0.25-0.94). Depressive symptoms were related to anxiety symptoms (OR 5.88, 95%CI 3.15-10.99) and female gender (OR 1.81, 95%CI 1.04-3.16). Patients with anxiety and depressive symptoms had lower functional ability and quality of life than patients without symptoms on admission and at discharge. After the rehabilitation program, patients without anxiety symptoms showed improvement in functional outcome and QOL. However, patients with or without depression symptoms have improvement in functional outcome after rehabilitation. However patients without depressive symptoms showed more items improvement in QOL than patients with depression. CONCLUSION: Symptoms of anxiety and depression are common after stroke. They are correlated with each other. Female gender also related to depressive symptoms. Patients with anxiety and depressive symptoms have lower functional ability and quality of life than those without symptoms.

An epidemiologic study of the Thai Stroke Rehabilitation Registry (TSRR): a multi-center study.

OBJECTIVE: To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. MATERIAL AND METHOD: Demographic data including medical history and pathology of stroke were recorded. All subjects received a comprehensive rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Three hundred twenty seven patients met the inclusion criteria. The mean age was 62 +/- 12 years, and 59% were males. Most of the patients were married (73.1%), lived in an urban area (62.1%), and had an education level of primary school or lower (58.7%). The median duration from onset to admission for rehabilitation was 24 days. The major medical history was hypertension (74.9%), followed by dyslipidemia (54.4%), diabetes mellitus (26.6%), and ischemic heart disease (18.0%). Fifty-one (15.6%) patients had a history of previous stroke. Cerebral infarction was found in 71.9%, including thrombosis (45.3%), lacuna infarction (15.3%), and emboli (8.0%) and 28.1% had hemorrhagic stroke. On admission, more than half (51.8%) had cognitive impairment and one-third (31.5%) had bowel-bladder problems. Almost all of the patients (99.4%) had family support. Either their spouse or siblings had undertaken the main caregiver role (46.5% and 40.4% respectively). However, more than 80% of the patients were discharged to their own homes or immediate family's house. CONCLUSION: This was the first multi-center registry of inpatient stroke rehabilitation in Thailand. It presented the epidemiologic aspects in order to become national data of stroke patients receiving medical rehabilitation services.

Factors associated with vocational reintegration among the Thai lower limb amputees.

BACKGROUND: Vocational reintegration is an important goal in the rehabilitation process. The amputees had to take time to adjust themselves to their new condition after lower limb amputation and that might have an impact on their vocation. As yet, there has been no information regarding vocational reintegration among the lower limb amputees in Thailand. OBJECTIVES: To study the rate of vocational reintegration, factors associated with vocational reintegration among the lower limb amputees. MATERIAL AND METHOD: The postal survey with the questionnaires to 1,300 amputees who received the lower limb prostheses between 2001 and 2005 was conducted. The participants were divided into two groups namely the employed and unemployed groups. The Chi-Square and the Independent Sample T Test were used to compare the difference between the two groups. The multiple variables analysis by stepwise logistic regression was used to determine the associated factors. RESULTS: Three hundred and nine questionnaires were completed among 321 returned questionnaires (response rate 24.7%). Two hundred and forty seven males and 62 females with age ranging from 18-82 years old participated. The rate of vocational reintegration was 66.7%. Demographically, the employed group had less diabetes mellitus (p = 0.001), higher educational level (p = 0.004), were younger at the time of amputation (p < 0.001) and etiologies of amputation were blast injury from mines and congenital problems (p = 0.005). Prosthetic use and problems: the employed group used no gait aids (p < 0.001), had satisfactory to good wearing comfort (p = 0.005), wore prostheses longer hours per day (p < 0.001). The factors associated with vocational reintegration were etiologies of amputation from the blast injury from mines and congenital problems (OR 3.3), educational level from secondary school (OR 2.3), at least satisfactory to good wearing comfort (OR 1.16), and younger at the time of amputation (OR 0.97) respectively. CONCLUSION: This information can assist the rehabilitation personnel to encourage the vocational reintegration among the Thai lower limb amputees.

Knowledge and practice of physical exercise among the inhabitants of Bangkok.

OBJECTIVE: To study the knowledge and practice of physical exercise among the inhabitants of Bangkok. The factors correlated with knowledge and the practice of physical exercise, were also explored. MATERIAL AND METHOD: A self-administered questionnaire was designed to survey 1200 inhabitants in Bangkok and the vicinity aged more than 18 years old. RESULTS: One thousand one hundred and seven people aged ranging from 18-81 years old completed the questionnaires (response rate 92.25%). Six hundred and forty people (58.4%) exercised regularly. The exercise was performed 1-2 days per week with varied duration. They performed exercises alone, in their homes, in the evening. They did not report any expenditure on the exercises. Common types of exercise reported were walking, jogging, attending an aerobic exercise class, using an exercise machine, and callisthenic exercise. Two hundred and seven people (18.9%) did not perform exercise at all because of the lack of time. The factors correlated with regular exercise were the increasing age, the high level of education, the amount of free time per day, and the enjoyment of exercise. With relation to knowledge of exercise, most people lacked knowledge of the benefits of exercise rather than how to do exercise and when to stop exercising. People who had a higher educational level than secondary school and a high income, practiced exercise everyday. They acquired their knowledge of exercise from attending an exercise course. CONCLUSION: People living in Bangkok usually performed regular exercises of 1-2 days per week with varied duration. The majority lacked knowledge of the benefits of exercise. Educational level of the samples was the only factor correlated with both regular exercise and knowledge of exercise.

Factors associated with functional improvement at discharge in stroke rehabilitation.

Objective: To study the factors associated with the functional improvement at discharge in stroke patients receiving inpatient rehabilitation. Methods: Retrospective review of the medical records of all the stroke patients admitted to inpatient rehabilitation, Department of Rehabilitation Medicine, Siriraj Hospital from January 2005 to December 2005. Results: There were sixty-one stroke patients, 39 males and 22 females, with a mean age 62.5 years old. Most of them lived with their spouses (61%) and had cerebral infarction (61%). The risk factors of stroke reported were hypertension (86.9%), dyslipidemia (63.9%), diabetes mellitus (34.4%), previous stroke (31.1%), heart disease (18%), smoking (8.2%) and regular alcoholic drinking (3.3%) respectively. The right and left side weakness were equally reported. The median duration of stroke before admission was 62 days. The disabilities at admission were urinary incontinence (39.3%), dysphagia (32.8%), and aphasia (26.2%). During the hospital stay, the complications which occurred were shoulder problems (41%), other musculoskeletal pain (34.4%), depression (26.2%), shoulder hand syndrome (13.1%), urinary tract infection (6.6%), and pneumonia (4.9%) respectively. Forty-seven patients (77%) gained functional improvement at discharge. The Chi-Square and Independent Sample T tests revealed the association between the functional improvement at discharge and urinary continence on admission (p=0.011), and duration of stroke within 3 months before admission to rehabilitation (p=0.011) with the odds ratio 5.9 and 5.3 respectively. Conclusions: The functional improvement after the process of inpatient stroke rehabilitation was associated with the duration of stroke within 3 months before rehabilitation admission and urinary continence on admission.

Prevalence and correlative factors of poststroke urinary incontinence.

Objective: To determine the prevalence and pattern changes of urinary incontinence in the first 3 months after stroke. The correlation between urinary incontinence and cognitive impairment, physical impairment and functional disability were also explored. Methods: One hundred acute stroke patients who had their first ever stroke without urinary incontinence were recruited. Canadian Neurological Scale, Barthel Index, Thai Mental State Examination, and Urogenital Distress Inventory Short Form were administered 3 times:, within 7days, at 1 and 3 months after stroke. Results: The prevalence of urinary incontinence within 7 days, at 1 month and 3 months after stroke were 34%, 22.1% and 17%, respectively. The incontinence pattern improved 18% at 1 month and 21 % at 3 months. The main type of incontinence found was urge incontinence. The initially incontinent group at 7 days was significantly more aphasic and dysphagic. Urinary incontinence correlated moderately with physical impairment and functional disability across all the three times of evaluations. There was no correlation between urinary incontinence and cognitive impairment. Conclusion: Urinary incontinence in acute stroke patients improves over time. Urge incontinence is the major problem in the incontinence group. The stroke patients with urinary incontinence have more physical impairments and disability than those with continence.

Efficacy of shoulder slings in shoulder subluxation of stroke patients.

OBJECTIVE: To assess the efficacy of the two types of shoulder slings in reducing shoulder subluxation in acute stroke patients. MATERIAL AND METHOD: Twenty-one acute stroke patients with shoulder subluxation were assessed for the subluxation distance before and after wearing the slings by physical examination and radiological measurement. The comparison by radiological measurement was performed by two radiologists who were blinded to each other as well as to the types of sling used. RESULTS: The mean difference of subluxation distance on the affected side after wearing the slings number 1 and 2 were 0.48 mm and 1.14 mm respectively on physical examination and 2.09 mm and 1.14 mm respectively on radiological assessment. There was no statistically significant difference of subluxation distance on either physical examination or radiological assessment (p > 0.05). CONCLUSION: There was no difference in efficacy of shoulder slings in reducing shoulder subluxation in acute stroke patients.