Factors associated with delayed discharges after inpatient stroke rehabilitation in Singapore

<p><b>INTRODUCTION</b>This study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation.</p><p><b>MATERIALS AND METHODS</b>A retrospective cohort study utilising medical notes review was conducted at an inpatient rehabilitation centre in Singapore. Acute stroke patients (n = 487) admitted between March 2005 and December 2006 were studied. The primary measure was delayed discharge defined as an extension in inpatient stay beyond the planned duration. Factors associated with delays in discharge were categorised as individual, caregiver, medical and organisational.</p><p><b>RESULTS</b>There were a total of 172 delayed discharges (35.6%). The mean [standard deviation (SD)] length of stay was 40.5 days (SD, 19.5 days) and 25.8 days (SD, 11.4 days) for patients with delayed and prompt discharges, respectively. Mean extension of stay was 9.7 days (SD, 13.8 days). Caregiver-related reasons were cited for 79.7% of the delays whereas organisational factors (awaiting nursing home placement, investigations or specialist appointments) accounted for 17.4%. Four factors were found to be independently associated with delayed discharge: discharge to the care of foreign domestic helper, nursing home placement, lower admission Functional Independence Measure (FIM) motor score and discharge planning process.</p><p><b>CONCLUSIONS</b>Our study suggests that caregiver and organisational factors were main contributors of delayed discharge. Targeted caregiver training and the provision of post-discharge support may improve the confidence of caregivers of patients with greater motor disability. The use of structured discharge planning programmes may improve the efficiency of the rehabilitation service. To reduce delays, problems with the supply of formal and informal post-discharge care must also be addressed.</p>

A brief review of traumatic brain injury rehabilitation

<p><b>INTRODUCTION</b>This article aims to provide an overview of the epidemiology, medical and rehabilitation issues, current evidence for traumatic brain injury (TBI) rehabilitation, recent advances and emerging practices. Special TBI population groups will also be addressed.</p><p><b>MATERIALS AND METHODS</b>We included publications indexed in Medline and the Cochrane Database of Systemic Reviews from 1974 to 2006, relevant chapters in major rehabilitation texts and Physical Medicine and Rehabilitation Clinics of North America and accessed Internet publications.</p><p><b>RESULTS</b>TBI has been implicated by the World Health Organisation to be a 21st century epidemic similar to malaria and HIV/AIDS, not restricted to the developed world. One third of patients may suffer severe TBI with long-term cognitive and behavioural disabilities. Injuries to the brain do not only damage the cerebrum but may give rise to a multisystem disorder due to associated injuries in 20% of cases, which can include complex neurological impairments, neuroendocrine and neuromedical complications. There is promising evidence of improved outcome and functional benefits with early induction into a transdisciplinary brain injury rehabilitation programme. However, TBI research is fraught with difficulties because of an intrinsically heterogeneous population due to age, injury severity and type, functional outcome measures and small samples. Recent advances in TBI rehabilitation include task-specific training of cognitive deficits, computer-aided cognitive remediation and visual-spatial and visual scanning techniques and body weight-supported treadmill training for motor deficits. In addition, special rehabilitation issues for mild TBI, TBI-related vegetative states, elderly and young TBI, ethical issues and local data will also be discussed.</p>

Brain Injury Rehabilitation in Singapore- the Tan Tock Seng Hospital Experience

In the past decade, head injury admissions in Singapore have shown a rising trend. With improved neurosurgical and neuroanaesthetic care, survival following severe head injury has also improved. However, many survivors may be left with residual chronic disabilities requiring rehabilitation. Since the mid eighties, Traumatic Brain Injury [TBI] rehabilitation propammes which offer coordinated multidisciplinary rehabilitation have been shown to result in improved functional outcome these programmes now constitute accepted rehabilitation practice in many developed countries. In South-East Asia, this rehabilitation concept remains relatively new. We present a brief overview of our rehabilitation facility's TBI rehabilitation programme as a possible rehabilitation model for other countries in the region