Unit cost of stroke rehabilitation.

BACKGROUND: Rehabilitation costs borne by the service institution are part of the total cost incurred when a patient is admitted to hospital. The total costs cannot directly represent the rehabilitation costs. When considering the funding allocated for specific services, it is useful to have figures that represent the actual costs of those services. OBJECTIVE: Study the unit cost of rehabilitation. MATERIAL AND METHOD: The data were collected from March to December 2006. Three hundred twenty seven patients from nine collaborating centers, including 18 patients from Sirindhron National Medical Rehabilitation Center (SNMRC) participated in this study. Descriptive analysis produced results in percent, mean standard deviation, and p-value. One unit of rehabilitation treatment is equal to twenty minutes. RESULTS: The average unit cost of rehabilitation treatment among the nine collaborating centers was 94.56 units per week and 33.78 from rehabilitation nursing. At SNMRC, the average rehabilitation unit was 32.67 units per week and the cost for rehabilitation was 11,170.56 +/- 5641.73 baht. CONCLUSION: The calculated unit cost was 60 baht/20 minutes service time.

Age-related rehabilitation outcome in stroke patients.

BACKGROUND: Patients who survive a stroke usually have residual neurological deficits. Consequently, a rehabilitation program is valuable for improving their quality of life (QOL). However, age is a known factor that needs qualification vis-à-vis rehabilitation outcomes among Thai patients. OBJECTIVE: To study the functional and psychological outcomes and the QOL before and after rehabilitation program among three age groups of Thai stroke patients (< or = 44, 45-64 and > or = 65 years of age). STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Three hundred and twenty seven stroke patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO QOL BREF questionnaire before and after undergoing an in-patient rehabilitation program. Data were collected from nine sites around Thailand. RESULTS: Functional and psychological outcomes and the quality of life score improved after the rehabilitation program. The youngest group of stroke victims showed the greatest improvement in functional outcome and QOL score in both the physical and social domains. No significant difference was found regarding anxiety and depression among the three groups. CONCLUSION: An in-patient rehabilitation program was of benefit to Thai stroke patients but age significantly determined rehabilitation outcomes.

Quality of life after stroke rehabilitation among urban vs. rural patients in Thailand.

BACKGROUND: Stroke patients who live in different areas might have different adjustments for their impairment and disability after stroke attack. These factors should be evaluated in Thai patients. OBJECTIVE: To compare functional outcome, psychological outcome and quality of life of stroke patients who live in urban vs. rural areas, before and after an in-patient rehabilitation program. STUDY DESIGN: A multi-center, prospective, analytical study. MATERIAL AND METHOD: Urban and rural stroke patients admitted to the rehabilitation ward received a rehabilitation program. Pre- and post-rehabilitation, patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO BREF QOL questionnaire. The data were collected from nine rehabilitation centers in Thailand. RESULTS: Significant improvement in functional outcome, psychological condition and quality of life score was achieved via the rehabilitation program in both groups. There was no statistically significant difference between urban vs. rural patients. CONCLUSION: Previous living areas (urban vs. rural) before admission had no effect on functional outcome, psychological outcome and quality of life among stroke patients after an in-patient rehabilitation program conducted in Northeast Thailand.

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.