Functional limitation and health-related quality of life, and associated factors among long term stroke survivors in a Malaysian community.

PURPOSE: this study aimed to evaluate function and quality of life (QoL) and associated factors among long term stroke survivors in the Malaysian community. METHODS: A cross-sectional study was conducted involving stroke survivors living in the community at two or more years post-stroke. Eligible participants with the diagnosis of stroke were identified from 2005-2010 case mix database of a tertiary hospital. the patients' medical records were analysed and data on demographic and clinical profiles were collected. telephone interviews were conducted to assess existing stroke-related impairments, comorbidities, stroke recurrences, current level of function and QoL, with the usage of rivermead mobility index (rMI), barthel index (bI) and stroke specific quality of life scale (ssQOL). RESULTS: A total of 203 stroke survivors; mean age 64.5 (standard Deviation(sD) 12.2) years, 45.3% males, stroke duration 44.7 (sD 13.8) months completed the interviews. Mean rMI was 11.7 (sD 3.4) and bI was 89.8 (sD 19.8). Forty three percent and 99% had difficulty in ascending/descending stairs and fast walking, respectively. Up to 20% had limitations in most of the bI subsets. Mean ssQOL was 207.6 (sD 37.2), with domains mostly affected were 'energy' and 'social role'. Function and QOL were both influenced by age (p<0.01) and stroke related impairments (p<0.05), but not by co-morbidities or stroke recurrence. QoL and function (both mobility and ADL) were strongly positively correlated with each other (p<0.01). CONCLUSIONS: It was observed that functional limitations especially mobility, remains post-stroke major problem and were attributed mainly to stroke-related impairments.

Direct medical cost of stroke: findings from a tertiary hospital in malaysia.

This study aimed to estimate cost of in-patient medical care due to stroke in a tertiary hospital in Malaysia. A retrospective analysis of stroke patients admitted to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between January 2005 and December 2008 were conducted. Cost evaluation was undertaken from the health provider's perspective using a top-down costing approach. Mean length of stay (LOS) was 6.4 ± 3.1 days and mean cost of care per patient per admission was MYR 3,696.40 ± 1,842.17 or 16% of per capita GDP of the country. Human resources made up the highest cost component (MYR 1,343.90, SD: 669.8 or 36% of the total cost), followed by medications (MYR 867.30, SD:432.40) and laboratory services (MYR 337.90, SD:168.40). LOS and cost of care varied across different stroke severity levels (p<0.01). A regression analysis shown significant influence of stroke severity on cost of care, with the most severe stroke consumed MYR 1,598.10 higher cost than the mild stroke (p<0.001). Cost of medical care during hospital admission due to stroke is substantial. Health promotion and primary prevention activities need to take priority to minimise stroke admission in future.

Schoolbag Weight, its Content, and Incidence of Back Pain in Different Medium Primary Schools in Kuala Lumpur

Introduction: Schoolbag weight across different types of school and schoolbag content has not been studied in Malaysia.This cross sectional survey determines the weight of schoolbags, its content and occurence of back pain among primary school children in different medium primary school in Kuala Lumpur.Methods: Students' body weight, and schoolbags weight were measured using a calibrated scale. Schoolbag content was examined, and weighed according to necessary learning materials or unnecessary materials. Back pain in the past one week was assessed using a self-administered questionnaire, adapted from previous studies. Results: A total of 358 students (167 male, 191 female) were enrolled, of which 119 were from National School (NS), 122 from Chinese Medium School (CMS) and 117from Tamil Medium School (TMS). The mean schoolbag weight was 4.55 ± 1.62kg for NS, 8.53 ± 1.94kg for CMS and 6.06 ± 2.09kg for TMS, which was 11.7%, 22.0% and 16.6% of body weight, respectively. The mean weight of unnecessary schoolbag content was 0.64(0.91)kg for NS, 2.18 (1.49) kg for CMS and 1.96(1.56) for TMS students. Back pain was detected in 87.0% NS students, 68.0% CMS students and 66.7% TMS students. Significant asociation was found between occurence of back pain and types of school (X²=16.64,p=0.00). Conclusions: Students from all the three mediums primary school, in particular Chinese medium school carry school bag heavier than that generally recommended, with unnecessary materials weigh up to 2kg. The occurence of back pain is high and this is associated with the types of school.