Factors influencing home modification of stroke patients.

BACKGROUND: Home modification for stroke victims is often necessary to prevent falls and enable them to have a better quality of life. Up-to-date relationship between personal factors and home modifications in post-stroke patients has not been investigated. OBJECTIVE: To identify significant personal factors influencing the requirement for home modification in post-stroke patients. STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Two hundred eighty one post-stroke patients were recruited from nine tertiary rehabilitation centers in Thailand. All patients received inpatient rehabilitation programs until either they reached the rehabilitation goals or registered two consecutive stable weeks as measured by their Barthel index score. Personal factors related to home modification were assessed at study entry, during hospital stay and at discharge. The correlation between personal factors and necessities of home modification in post-stroke patients were reported through univariate and multivariate modeling. RESULTS: The results of univariate analysis showed that a low Barthel index score (< or = 14/20) (at baseline and discharge), low Brunnstrom stage of arm or leg (< or = IV/VI) at baseline, and intolerance to intensive rehabilitation programs (< 3 hr/day) indicated a necessity for modifications in the patient's home (p < 0.05). The results of multivariate modeling showed that a low Barthel index score (at baseline and discharge), and intolerance to intensive rehabilitation were significant predictors of a requirement for home modification (p < 0.05). CONCLUSION: A low level of physical functioning and intolerance to intensive rehabilitation are significant predictors for the necessity of home modifications in stroke victims.

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.

Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischemic stroke.

BACKGROUND: The stroke unit has been established as a standard care for stroke. However, it has not been widely established in developing countries due to the lack of understanding and limited resources. OBJECTIVE: To compare the complications and mortality of stroke patients admitted in the stroke unit and short-term ward with those admitted in the general medical ward. MATERIAL AND METHOD: The authors prospectively collected data of acute stroke patients who were admitted after the set up of the stroke unit and stroke short-term ward in 2003, and compared with the data of those who were admitted in a general medical ward in 2001. All acute stroke patients who presented within seven days of the onset were admitted and those who had final diagnosis of ischemic stroke or transient ischemic attack (TIA) were studied. Patients in the stroke unit were taken care of by a multidisciplinary team approach under clinical guidelines and a care map. The short-term ward is a part of the general medical ward and stroke patients were treated by a multidisciplinary team followed by homecare treatment. The endpoints were mortality rate, neurological and medical complications during admissions, and the mean length of stay. RESULTS: Seven hundred and ninety-four patients were studied. Three hundred and eighty-seven patients were admitted in 2001 and 407 patients in 2003. Among patients presented 2003, three hundred and one cases were treated in the acute stroke unit whereas 106 were admitted in the short-term ward. There was no difference in stroke risk factors and stroke subtypes between the two groups, except for dyslipidemia and cigarette smoking, which were more prevalent in patients admitted in 2003. Patients in the stroke unit and the short-term ward had significantly less mortality than those in the general medical ward (8.9 and 2.1%). Overall complications in the stroke unit and the short-term ward were 16.8%, compared to 26% of those admitted into the general medical ward. Significantly less brain edema, hemorrhagic infarction, urinary tract infection, pneumonia, and pressure sore were also observed. The length of hospital stay of the patients admitted in 2001 and 2003 was 11.26 and 8.09 days, respectively. CONCLUSION: Combination of organized acute stroke unit and short-term ward with early supported discharge reduces the mortality and complications of ischemic stroke patients during admission as well as the length of stay when compared to the general medical ward. The present study reassures that the combination is useful for hospitals in developing countries, which have limited number of beds in their stroke units.

Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome.

OBJECTIVE: To investigate the efficacy of low intensity ultrasound thermotherapy, a conservative option of treatment of mild to moderate carpal tunnel syndrome (CTS). DESIGN: Prospective experimental, placebo- controlled, before-after treatment trial. SETTING: King Chulalongkorn Memorial Hospital, Outpatient Clinic and Electrodiagnostic Laboratory, Department of Rehabilitation Medicine. PATIENTS: Eighteen women, 30 hands who had clinical and electrophysiologic evidence of mild to moderate CTS. INTERVENTIONS: Patients of CTS were divided into two groups; A and B of 15 hands by random sampling. Group A was given placebo and continuous ultrasound therapy with the intensity of 0.5 W/cm2 applied to the palmar carpal tunnel for 10 minutes. Group B was given Diclofenac 75 mg/day in divided doses and sham ultrasound. The ultrasound was applied 5 days a week for 4 weeks. OUTCOME MEASURES: Each patient was clinically and electrophysiologically evaluated before and after treatment. RESULTS: There were statistically significant improvements (p < 0.05), in the clinical parameters of both groups after treatment. In the electrophysiologic study, the median SNAP amplitude was increased significantly after the treatment in ultrasound group (group A). When both groups were compared, group A had significant difference in increasing of median SNAP amplitude after treatment. CONCLUSION: The therapeutic efficacy of low intensity ultrasound thermotherapy was satisfied for mild to moderate CTS. However, the electrophysiological changes after ultrasound treatment need further investigation.

Risk factors for stroke in Thai patients.

OBJECTIVE: To demonstrate risk factors for stroke in Thai patients at King Chulalongkorn Memorial Hospital. DESIGN: Analytic cross-sectional study. SETTING: Stroke unit, Department of Neurology, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The patients admitted to the stroke unit of King Chulalongkorn Memorial Hospital with the diagnosis of acute stroke and community-based age control matched subjects were recruited. They were counselled about the possible risk factors for stroke and the stroke patients' medical records were carefully reviewed within 72 hours after admission. This study was done from November 2001 to May 2002. There were two hundred stroke cases and one hundred control subjects enrolled in the present study. The possible risk factors were compared between the two groups. RESULTS: The male:female stroke patients were 1.2:1 with a mean age of 63.10 +/- 12.76 years. The etiology of stroke was ischemic 78 per cent and hemorrhagic 22 per cent. The mean duration of stroke onset was 4.11 +/- 1.96 days. The risk factors for stroke with their relative risks were: transient ischemic attack (TIA) 9.3, previous stroke 9, moderate to severe hypertension (HT) 6.5, heart disease 5.2, hyperlipidemia 4.6, diabetes mellitus 4.5, current smoking 3.8 and daily drinking 3.6. Whereas, physical exercise showed a protective effect on the development of stroke. CONCLUSION: Risk factors for stroke in Thai patients at King Chulalongkorn Memorial Hospital were TIA, previous stroke, moderate to severe HT, heart disease, hyperlipidemia, diabetes mellitus, current smoking and daily drinking. Physical exercise was a positive predictor.