OBJECTIV E: To investigate the effectiveness and efficiency of inpatient rehabilitation. METHODS: A total of 2,081 patients across 14 hospitals were recruited in this prospective, multicenter cohort study. Data on the diagnoses, types of... more
OBJECTIV E: To investigate the effectiveness and efficiency of inpatient rehabilitation. METHODS: A total of 2,081 patients across 14 hospitals were recruited in this prospective, multicenter cohort study. Data on the diagnoses, types of admission, length of stay (LOS), and functional ability score based on a modified Barthel index (BI) at admission (BIa) and at discharge (BId) were col lected. Effectiveness was defined as the difference of BI ( ΔBI) and efficiency as Δ BI divided by LOS. RESULTS: The majority of patients were diagnosed with spinal cord injury and stroke (41.8% and 37.5%, respectively). The mean age was 52.4 ± 18.6 years with a mean LOS of 23.9 ± 19.9 days, BIa of 9.4 ± 6.1, and BId of 12.3 ± 5.7. The overall effectiveness and efficiency were 2.9 ± 3.4 and 0.16 ± 0.30 scores/day, respectively; stroke rehabilitation provided the most effective and efficient BI improvement compared with rehabilitation for other diseases. Most patients (54.5%) received intensive functi...
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Objective: To investigate the quality of life (QoL) and factors significantly associated with QoL of stroke patients at 1 year after discharge from post-stroke inpatient rehabilitation. Materials and Methods: This study included patients... more
Objective: To investigate the quality of life (QoL) and factors significantly associated with QoL of stroke patients at 1 year after discharge from post-stroke inpatient rehabilitation. Materials and Methods: This study included patients from 9 rehabilitation centers. QoL of stroke patients was evaluated using the World Health Organization Quality of Life Instrument Brief Version. Patient QoL scores at the 1-year follow-up were compared with those recorded at discharge from inpatient rehabilitation. Factors related to QoL at one year after discharge were identified using univariate analysis and multiple linear regression. Results: One hundred and ninety-seven patients were recruited with a mean age of 63.3±12.4 years. Of the 197 patients that were recruited, 21 (10.7%) were readmitted during the 1-year post-discharge period. Of those, there were 16 single readmissions, and 5 double readmissions. The mean QoL score at one year after discharge was significantly lower than the score at...
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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... more
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...
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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... more
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 2...
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BACKGROUND This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body... more
BACKGROUND This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body contortion which still lacks systematically conducted evidence-based regarding its benefits. MATERIAL AND METHOD Thirty-seven participants who have routinely worked on computer at least 3 hours per day were recruited and randomized into intervention (n = 19) or control group (n = 18). Physical effect on shoulder joints was evaluated by measuring shoulder range of motion (ROM) and evaluating shoulder function with the American Shoulder & Elbow Surgeons Standardized Shoulder Assessment Form. Cognitive function was determined by Verbal Fluency Test, Trail Maker B Test, and Digit Span Test. Both study groups were assessed by all tests at the beginning and at the end of study by blinded assessors. The intervention group performed 3 postures of Rue-si-dad-ton exe...
Research Interests: Cognition, Thailand, Exercise therapy, Humans, Female, and 7 moreMale, Exercise, Posture, Middle Aged, Adult, Pilot Projects, and Shoulder joint
Handicap exists when individuals with impairment or disability are unable to fulfill one or more of the roles that are considered normal for their age, gender, and culture. In fact, handicap is one of the most poorly measured of all... more
Handicap exists when individuals with impairment or disability are unable to fulfill one or more of the roles that are considered normal for their age, gender, and culture. In fact, handicap is one of the most poorly measured of all rehabilitation outcomes. This study was performed to measure the subjective experience of handicap in spinal cord injury (SCI) patients who had permanent disabilities and were often faced with environmental barriers. Eighty-three new traumatic SCI patients with a mean age of 33 years were interviewed during follow-up outpatient clinic visits using the Perceived Handicap Questionnaire (PHQ). This test provides a global measurement of the extent of self-perceived handicap across five dimensions based on the WHO's classification of handicap. When compared with normal persons, SCI subjects perceived themselves as more handicapped in all dimensions especially mobility and physical independence. In contrast, the majority of SCI subjects perceived themselve...
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OBJECTIVES To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. MATERIAL AND METHOD The Thai stroke rehabilitation registry (TSRR) was conducted... more
OBJECTIVES To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. MATERIAL AND METHOD The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. RESULTS There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee fle...
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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,... more
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 ...
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The objective of this retrospective study was to investigate rehabilitation outcomes according to type of rehabilitation program (intensive or non-intensive) in stroke patients admitted for rehabilitation at Siriraj Hospital during... more
The objective of this retrospective study was to investigate rehabilitation outcomes according to type of rehabilitation program (intensive or non-intensive) in stroke patients admitted for rehabilitation at Siriraj Hospital during 2010-2014. Demographic data, Barthel Index (BI) at admission (BIad), Barthel Index at discharge (BIdc), and length of stay (LOS) of all stroke admitted during the study period were recorded from chart review. Patients were categorized into the intensive or non-intensive rehabilitation groups. Efficacy (∆BI) was calculated as BIdc-BIad, and effectiveness was calculated as ∆BI / (BImax-BIad) * 100. Our subjects were 484 stroke patients with 569 rehabilitation admissions. Mean age was 64.5±13.0 years, and 53% were male. Most (88%) patients were admitted for intensive rehabilitation. Mean efficacy score was 3.7±3.5, and mean LOS was 30.6±18.4 days. Median percentage of effectiveness was 27.0 (800, 100). Mean efficacy score was 4.1±3.5 and 0.9±1.9; median perc...
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... more
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%, incl...
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OBJECTIVES: To identify factors that are independently related to interrupted stroke rehabilitation due to acute care transfer or death. METHODS: Medical records of stroke inpatients admitted from 2012 to 2017 were reviewed. Stroke... more
OBJECTIVES: To identify factors that are independently related to interrupted stroke rehabilitation due to acute care transfer or death. METHODS: Medical records of stroke inpatients admitted from 2012 to 2017 were reviewed. Stroke inpatients with interrupted stroke rehabilitation due to acute care transfer or death were enrolled into the case group. Those without interruption admitted in the same month were randomly selected into the control group (case to control ratio of 1 : 5). Ten clinical factors were studied. RESULTS: Among stroke inpatients, 3.2% were transferred to acute care facilities and 0.2% died. The most common causes of acute care transfer were respiratory tract infection, intracranial hemorrhage, recurrent ischemic stroke, ischemic heart disease, and seizure. Three factors were found to be significantly associated with interrupted stroke rehabilitation, i.e. presence of feeding tube, presence of anemia and age. Our results also revealed significant association betwe...
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Objective: To determine the prevalence of sarcopenia in knee osteoarthritis (SKOA) and associated factors among age, gender, body mass index (BMI), nutritional status, knee pain score, knee pain duration, physical activity, and exercise... more
Objective: To determine the prevalence of sarcopenia in knee osteoarthritis (SKOA) and associated factors among age, gender, body mass index (BMI), nutritional status, knee pain score, knee pain duration, physical activity, and exercise frequency. Methods: Knee osteoarthritis (OA) and sarcopenia were diagnosed using American College of Rheumatology and Asian Working Group for Sarcopenia criteria, respectively. Results: Prevalence of SKOA using grip strength and quadriceps strength was 2.2% and 9.4%, respectively. There was no significant association between sarcopenia and knee OA. Low BMI and poor nutritional status were significantly associated with SKOA. Conclusions: No association between sarcopenia and knee OA was found in this study.
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BACKGROUND AND AIM Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways,... more
BACKGROUND AND AIM Stroke is one of the leading causes of death, physical disability, and economic burden. Nowadays, various types of rehabilitation are available. Rehabilitation centers in Thailand provide services in different ways, including starting time, duration, and frequency of each therapy. In addition, many rehabilitation wards have a standing policy to reduce length of stay (LOS) due to economic considerations. This study aimed to compare the effectiveness and efficiency between intensive and nonintensive rehabilitation protocol for stroke patients. METHODS This prospective, multicenter cohort study was conducted among stroke patients who admitted to rehabilitation wards at 14 centers. All participants received either intensive or non-intensive rehabilitation program. Barthel Index (BI) at admission (BIad), BI at discharge (BIdc), and LOS were recorded. The effectiveness was difference in BIdc and BIad score (ΔBI), and the efficiency was ΔBI divided by LOS (ΔBI/LOS). RESULTS Seven hundred and eighty stroke patients were included. Mean age was 61.9 ± 13.3 years, and 59.7% were male. The majority of patients (79.5%) were admitted for intensive rehabilitation. Effectiveness and efficiency were significantly higher in the intensive group than in the nonintensive group (4.5 ± 3.4 versus 2.6 ± 3.2 and .24 ± .30 versus .18 ± .33, respectively). LOS, intensive rehabilitation, and quality of life were significantly positively correlated with effectiveness; whereas, age, onset to admission interval (OAI), and BIad were significantly negatively correlated with the effectiveness of stroke rehabilitation. CONCLUSIONS Stroke patients admitted for intensive rehabilitation had better effectiveness and efficiency than those admitted for non-intensive rehabilitation. Younger patients with shorter OAI, lower BIad, and longer LOS realized significantly enhanced effectiveness.
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Swallowing problems are a common symptom in patients suffering from stroke. The severity of swallowing problems associate with age, stroke types, and brain lesion. Early recognition of the problem can prevent complications such as... more
Swallowing problems are a common symptom in patients suffering from stroke. The severity of swallowing problems associate with age, stroke types, and brain lesion. Early recognition of the problem can prevent complications such as aspiration pneumonia, and malnutrition. To report the prevalence and the long-term outcome of dysphagia in patients with stroke. Data of patients with stroke admitted at nine rehabilitation wards/centers in Thailand were extracted from the Thai Stroke Rehabilitation Registry (TSRR) I and II (1-year follow-up). Of 327 stroke patients [mean age 62 (SD 12) years and male: female = 193:134], 49 (15%) had swallowing dysfunction at admission. Dysphagic patients had significantly more cognitive impairment (TMSE score <24) than non-dysphagic group (p = 0.01). There was no significant difference in age, gender, onset-admission interval, type of stroke, and modified Barthel Index score (mBI) between the two groups. Moreover, there was no relationship between dysp...
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To investigate the efficacy of a four-week underwater treadmill exercise regimen compared to a home exercise regimen relative to pain relief and functional improvement in obese patients with knee osteoarthritis. Single-blind randomized... more
To investigate the efficacy of a four-week underwater treadmill exercise regimen compared to a home exercise regimen relative to pain relief and functional improvement in obese patients with knee osteoarthritis. Single-blind randomized controlled trial. Outpatient. Eighty primary knee osteoarthritis with pain ⩾5/10 and body mass index ⩾25 kg/m. Daily quadriceps exercise at home for 30 minutes (control group) or underwater treadmill exercise (study group) for 30 minutes/day, three times/week for four weeks. Pain score, six-minute walking distance, quadriceps strength, and body weight were evaluated at baseline and after four weeks. Adverse events, global assessment, and satisfaction index were assessed at the end of study. All outcomes in both groups were significantly improved at the end of the study, except for body weight. The mean difference (95% confidence interval (CI)) in outcomes between groups were -0.53 (-1.31, 0.26) for pain; 10.81 (-11.9, 33.53) meters for 6-minute walkin...
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To study the prevalence of depression at 12 months after stroke and to analyze factors associated with depression. This prospective cross-sectional study was conducted among nine tertiary hospitals in Thailand. Stroke patients from the... more
To study the prevalence of depression at 12 months after stroke and to analyze factors associated with depression. This prospective cross-sectional study was conducted among nine tertiary hospitals in Thailand. Stroke patients from the Thai Stroke Rehabilitation Registry who were admitted in inpatient rehabilitation wards were recruited for evaluation at the 12-month follow-up time point. Hospital Anxiety and Depression Scale (HADS) was used to evaluate depression in stroke. A score of ≥11 was considered as having depression. Univariate and multivariate analysis was used to investigate factors related with depression in stroke. Two hundred stroke patients with a mean age of 62.1±12.5 years were recruited. Approximately 60% were male. The number of stroke patients with depression at the 12-month follow-up was 42 (21.0%, 95%CI 15.9%-27.2%). Mean HADS score at 12-month follow-up was not significantly different from those at discharge. However, 28 (16.5%) stroke patients who did not have depression at discharge developed depression during the 12-month period. From multivariate analysis, complications and urinary incontinence were found to be significantly associated with depression after stroke with adjusted odds ratio of 3.65 (95%CI 1.11-12.06) and 4.82 (95%CI 1.74-13.38), respectively. Depression is a common complication after stroke. This study found one-fifth of stroke survivors developed depression at the 12-month follow-up. Complications at discharge and urinary incontinence were significantly correlated with depression in multivariate analysis. Further study concerning interventions in decreasing depression should be performed in order to improve the quality of life of those stroke patients.
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Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted.... more
Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p &amp;amp;amp;amp;amp;amp;lt; 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) &amp;amp;amp;amp;amp;amp;lt;30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.
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ABSTRACT
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To examine the efficacy of creative art therapy plus conventional physical therapy, compared with physical therapy only, in increasing cognitive ability, physical functions, psychological status and quality of life of stroke patients.... more
To examine the efficacy of creative art therapy plus conventional physical therapy, compared with physical therapy only, in increasing cognitive ability, physical functions, psychological status and quality of life of stroke patients. Randomized controlled trial with blinded assessor. An in-patient setting PARTICIPANTS: One hundred and eighteen stroke patients aged ⩾50 years who could communicate verbally. All participants received conventional physical therapy five days per week. An intervention group received additional creative art therapy, twice a week for four weeks, in a rehabilitation ward. Cognitive function, anxiety and depression, physical performance and quality of life were measured with the Abbreviated Mental Test, the Hospital Anxiety and Depression Scale, the modified Barthel Index scale and the pictorial Thai Quality of Life questionnaire, respectively. Mean differences for the intervention group were significantly greater than the control group for depression (-4.5,...
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This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body contortion which... more
This study aims to preliminarily evaluate effect on physical properties of shoulder joints and cognitive function after practicing Rue-si-dad-ton, a Thai traditional exercise using the postures of the hermit doing body contortion which still lacks systematically conducted evidence-based regarding its benefits. Thirty-seven participants who have routinely worked on computer at least 3 hours per day were recruited and randomized into intervention (n = 19) or control group (n = 18). Physical effect on shoulder joints was evaluated by measuring shoulder range of motion (ROM) and evaluating shoulder function with the American Shoulder & Elbow Surgeons Standardized Shoulder Assessment Form. Cognitive function was determined by Verbal Fluency Test, Trail Maker B Test, and Digit Span Test. Both study groups were assessed by all tests at the beginning and at the end of study by blinded assessors. The intervention group performed 3 postures of Rue-si-dad-ton exercise (an hour per day for 4 da...
Research Interests: Cognition, Thailand, Exercise therapy, Humans, Female, and 7 moreMale, Exercise, Posture, Middle Aged, Adult, Pilot Projects, and Shoulder joint
To determine the effectiveness of neck and shoulder stretching exercises for relief neck pain among office workers. Randomized controlled trial. An outpatient setting. A total of 96 subjects with moderate-to-severe neck pain (visual... more
To determine the effectiveness of neck and shoulder stretching exercises for relief neck pain among office workers. Randomized controlled trial. An outpatient setting. A total of 96 subjects with moderate-to-severe neck pain (visual analogue score ⩾5/10) for ⩾3 months. All participants received an informative brochure indicating the proper position and ergonomics to be applied during daily work. The treatment group received the additional instruction to perform neck and around shoulder stretching exercises two times/day, five days/week during four weeks. Pain, neck functions, and quality of life were evaluated at baseline and week 4 using pain visual analogue scale, Northwick Park Neck Pain Questionnaire, and Short Form-36, respectively. Both groups had comparable baseline data. All outcomes were improved significantly from baseline. When compared between groups, the magnitude of improvement was significantly greater in the treatment group than in the control group (-1.4; 95% CI: -2...
Research Interests: Quality of life, Treatment Outcome, Exercise therapy, Workplace, Humans, and 15 moreTaiwan, Female, Male, Neck Pain, Confidence intervals, Follow-up studies, Posture, SHOULDER PAIN, Middle Aged, Adult, Clinical Rehabilitation, Reference Values, Pain Measurement, Severity of Illness Index, and Medical and Health Sciences
Study design:Retrospective study.Objectives:To study the effectiveness of inpatient rehabilitation in spinal cord injury (SCI) patients.Setting:Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital.Subjects:SCI patients... more
Study design:Retrospective study.Objectives:To study the effectiveness of inpatient rehabilitation in spinal cord injury (SCI) patients.Setting:Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital.Subjects:SCI patients admitted from 2006 to 2010.Methods:Medical records of SCI patients including baseline characteristic, functional score using Barthel index (BI), length of stay (LOS) and complications were reviewed. The effectiveness and efficiency were calculated by difference of BI admission and BI discharge (ΔBI) and ΔBI/LOS, respectively. The factors associated with the effectiveness were then determined by multivariate linear regression analysis.Results:There were 201 admissions with complete data. There were 164 (81.6%) admissions that had objective for intensive rehabilitation. The average LOS was 39.8 days (s.d.=23.6). BI score was significantly increased after inpatient rehabilitation with the effectiveness of 13.0 (s.d.=15.2) and BI efficiency of 0.37 sco...
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Regarding observations, stroke patients able to change their basic body position from supine to sitting at admission usually could walk by the end of rehabilitation. However, there was not yet supported by any research evidence. To study... more
Regarding observations, stroke patients able to change their basic body position from supine to sitting at admission usually could walk by the end of rehabilitation. However, there was not yet supported by any research evidence. To study the relationship between the patient's ability at admission to change basic body position from a supine to a sitting position and the mobility outcome after stroke rehabilitation. Data were gathered and analyzed from the case record forms (including the Barthel ADL Index assessment sheets) of 327 stroke patients in nine tertiary in-patient rehabilitation settings in Thailand between March and December 2006. On admission, 58.7% of the patients were able to change their basic position from supine to sitting. At the end of rehabilitation, the group which was able to sit had a higher mobility sub-score (OR = 6.15; 95% CI 3.24 -11.67) and total Barthel ADL index score (OR = 9.64; 95% CI 5.74-16.18) than the group which was unable to sit. The ability ...
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To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All... more
To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Sp...
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To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify factors associated to these conditions during rehabilitation period. Stroke patients from 9 rehabilitation centers from March to December 2006... more
To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify factors associated to these conditions during rehabilitation period. Stroke patients from 9 rehabilitation centers from March to December 2006 were enrolled in the present study. All subjects were registered for demographic data including risk factors and type of stroke. They were assessed for motor recovery, cognitive ability, functional ability, psychological reaction and quality of life by using Brunnstrom stage, Thai Mental State Examination (TMSE), Barthel ADL Index (BI), Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF questionnaires respectively at the beginning and the end of the present study. The occurence of shoulder subluxation and shoulder pain were recorded and then were analyzed for the associated factors. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. Of 376 stroke patients, 327 ...
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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... more
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. Study the unit cost of rehabilitation. 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. 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...
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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... more
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. 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). Prospective, analytical study. 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. 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 ...
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To report the efficacy of intra-articular injection of deproteinized hemodialysate including its side effects in a case-series of knee osteoarthritic (OA) patients. Intra-articular injection of deproteinized hemodialysate was performed in... more
To report the efficacy of intra-articular injection of deproteinized hemodialysate including its side effects in a case-series of knee osteoarthritic (OA) patients. Intra-articular injection of deproteinized hemodialysate was performed in 17 subjects (3 male and 14 female) with primary knee OA. Their average age was 63 years (min, max = 50, 80 yrs). The X-ray appearance was grade II-III according to Kellgren-Lawrence criteria. 100 mm visual analogue scale (VAS) and any side effects. The mean (95% CI) of the VAS before and after injection were 70.0 (59.9-80.1) and 42.7 (31.2-54.2) respectively, with a p-value of < 0.001. The mean difference in pain score was 27.35 (95% CI = 17.0-37.7). The symptoms of knee pain resolved in an average of 4.8 (2.9) days (min, max = 1, 10). No side effects were found. Intra-articular injection of deproteinized hemodialysate is effective and safe. However, a further controlled trial with an adequate sample size should be performed to confirm the effic...
Research Interests: Treatment Outcome, Medicine, Humans, Female, Male, and 4 moreAged, Middle Aged, Knee Osteoarthritis, and Blood Proteins
A prospective study of 83 patients with spinal cord injuries admitted to the Spinal Unit, Siriraj Hospital, Bangkok, Thailand from January 1997 to December 2000 was conducted. The average age was 33.2 +/- 11.7 years (range from 10 to 68... more
A prospective study of 83 patients with spinal cord injuries admitted to the Spinal Unit, Siriraj Hospital, Bangkok, Thailand from January 1997 to December 2000 was conducted. The average age was 33.2 +/- 11.7 years (range from 10 to 68 years) with a male: female ratio of 4 : 1. Most subjects (83.2%) were aged between 16-45 years. About half of them had no associated injuries and no financial problems. Three-fourths of the spinal injuries were caused by traffic accidents (49.4 and 25.3% car and motorcycle respectively). The other two causes were falls (16.9%) and gunshot wounds (8.4%). The neurological classification was as follows: 34 (41.0%) patients had ASIA D grade of injury, 28 (33.7%) were paraplegic with ASIA A, B or C grade and 21 (25.3%) were tetraplegic with ASIA A, B, or C grade. Traffic accidents most frequently resulted in an incomplete ASIA D grade (40.3%). Males were more predominant for all causes of injury especially motorcycle accidents. The average Barthel Index s...
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Handicap exists when individuals with impairment or disability are unable to fulfill one or more of the roles that are considered normal for their age, gender, and culture. In fact, handicap is one of the most poorly measured of all... more
Handicap exists when individuals with impairment or disability are unable to fulfill one or more of the roles that are considered normal for their age, gender, and culture. In fact, handicap is one of the most poorly measured of all rehabilitation outcomes. This study was performed to measure the subjective experience of handicap in spinal cord injury (SCI) patients who had permanent disabilities and were often faced with environmental barriers. Eighty-three new traumatic SCI patients with a mean age of 33 years were interviewed during follow-up outpatient clinic visits using the Perceived Handicap Questionnaire (PHQ). This test provides a global measurement of the extent of self-perceived handicap across five dimensions based on the WHO's classification of handicap. When compared with normal persons, SCI subjects perceived themselves as more handicapped in all dimensions especially mobility and physical independence. In contrast, the majority of SCI subjects perceived themselve...
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Research Interests:
Objectives: To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. Material and Method: The Thai stroke rehabilitation registry (TSRR) was conducted... more
Objectives: To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. Material and Method: The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai(26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. Results: There were 327 patients with a mean age of 62.2 years old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee f...
Research Interests:
The objectives of this study were to determine the efficacy and safety of Derris scandens Benth extracts in pain reduction and functional improvement in patients with knee osteoarthritis (OA). This was a prospective, randomized,... more
The objectives of this study were to determine the efficacy and safety of Derris scandens Benth extracts in pain reduction and functional improvement in patients with knee osteoarthritis (OA). This was a prospective, randomized, controlled trial, single-blinded (assessor). The study was conducted at the Rehabilitation Medicine Department, Siriraj Hospital. One hundred and seven (107) patients with primary OA knee who had pain score of ≥ 5 were recruited. Patients were randomized to receive naproxen 500 mg/day or Derris 800 mg/day for 4 weeks. Western Ontario McMaster Osteoarthritis Index (WOMAC) scores and 6-minute walking distance were the outcome measurements. Fifty-five (55) and 52 patients were randomized to Derris and naproxen groups, respectively. The mean differences of all WOMAC scores between 2 groups at week 4 adjusted by week 0 were within ± 1 point. The mean scores of the aforementioned outcomes at weeks 0, 2, and 4 were significantly improved compared to the baseline values. There was no difference of WOMAC scores between groups. The gastrointestinal irritation and dyspepsia were observed more often in the naproxen than in the Derris group. Derris scandens Benth extracts were efficacious and safe for the treatment of knee OA.
Research Interests: Pain, Complementary and Alternative Medicine, Treatment Outcome, Medicine, Phytotherapy, and 14 moreProspective studies, Humans, Walking, Knee, Female, Male, Complementary and Alternative Medicine in the Health Service, Aged, Middle Aged, Plant extracts, Knee Osteoarthritis, Naproxen, Mobility limitation, and Severity of Illness Index
Research Interests:
To search for a simple, practical and appropriate instrument for the assessment of depression among Thai SCI patients: comparison between two self-rating instruments. Eighty-three SCI patients were asked to complete a questionnaire... more
To search for a simple, practical and appropriate instrument for the assessment of depression among Thai SCI patients: comparison between two self-rating instruments. Eighty-three SCI patients were asked to complete a questionnaire composed of the Thai depression inventory (TDI) and the Center for Epidemiological Studies Depression Scale (CES-D), Thai version. All subjects were interviewed by a psychiatrist and were diagnosed according to the categories of depression of the Diagnostic and Statistical Manual of Mental fourth edition, (DSM-IV). Receiver Operating Characteristic (ROC) curve and Logistic regression analysis. Twenty patients were confirmed to have a depressed mood or adjustment disorder. The area under the ROC curve for the CES-D and TDI was 0.826 and 0.827. The sensitivities and specificities of the CES-D and TDI were 80.0, 69.8 per cent and 70.0, 79.4 per cent respectively. The positive predictive value and negative predictive value of the two tests were 45.7, 91.7 per cent and 51.9, 89.3 per cent. Using Logistic regression analysis, the CES-D produces a better model than the TDI (Chi-square value = 23.196 and 4.578). The CES-D is more appropriate for screening for depression in SCI patients than the TDI.
Research Interests:
To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. Demographic data including medical history and pathology of stroke were... more
To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. 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. 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&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s house. 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.
Research Interests:
Stroke affects the long-term quality of life and the well-being of patients and families. Stroke patients gain benefits from rehabilitation. Authors reported 1-year outcomes of stroke rehabilitation in 327 patients registered to the Thai... more
Stroke affects the long-term quality of life and the well-being of patients and families. Stroke patients gain benefits from rehabilitation. Authors reported 1-year outcomes of stroke rehabilitation in 327 patients registered to the Thai Stroke Rehabilitation Registry. The outcomes included death rate, readmission rate, functional ability score (Barthel Index, BI), and factors affecting BI score. Of 327 patients, 214 (65.4%) had adequate follow-up data for analysis. The average age was 62.1 ± 12.5 years, and 57.9% were male. The mortality rate was 2.5% and the readmission rate was 11.2%. The number of the patients who could function independently increased from 5.5% at discharge to 22.9% and 25.5% at month 6 and month 12, respectively. The change in functional ability level of 214 patients included improvement (51.5%), deterioration (12.8%), and equivocal (35.7%). The low functional score at month 12 was significantly correlated with longer length of stay (LOS), longer onset to admi...
To examine the frequency and types of complications in patients with stroke. A multicenter, prospective cohort study was performed in 327 patients with stroke (134 women, 193 men), who attended inpatient rehabilitation in nine centers.... more
To examine the frequency and types of complications in patients with stroke. A multicenter, prospective cohort study was performed in 327 patients with stroke (134 women, 193 men), who attended inpatient rehabilitation in nine centers. The frequency and severity of consequences and complications related to strokes were monitored weekly. In addition, correlations with stroke-related complications were analyzed. At least one complication after a stroke was found in 232 (71.0%) patients. The mean age was 62 (+/-12) yrs, and 59% were men. Shoulder subluxation was found in 37.3% with mild to moderate degree. Limb spasticity was presented in 41.6%, and almost all were a severity grade of less than 3 on the Modified Ashworth Scale. The common complications were musculoskeletal pain (32.4%), bowel/bladder dysfunction (31.5%), infection (16.5%), depression (13.8%), and anxiety (5.8%). Symptomatic urinary tract infection was found in 35 (10.7%) patients. Urinary incontinence was the most common among bowel/bladder problems (24.5%). Time since onset of stroke &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1 mo (adjusted odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.07-4.17), length of stay &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 21 days (adjusted OR = 2.36; 95% CI = 1.26-4.43), and anxiety score at admission &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 11 (adjusted OR = 6.87; 95% CI = 2.45-19.29) were statistically associated with stroke-related complications. Medical complications were common among patients with stroke who had been hospitalized longer, during inpatient rehabilitation and among those who had high anxiety scores.