Quality of Life of Stroke Patients at 1 Year after Discharge from Inpatient Rehabilitation: A Multicenter Study

Objective: To investigate quality of life (QoL) and its related factors 1-year after discharge from post-stroke inpatient rehabilitation. Methods: This longitudinal study was performed among 9 rehabilitation centres. Quality of life of stroke patients was evaluated using the WHOQOL-BREF. Its scores ranged from 26-130, with a higher score representing better quality of life. The QoL scores at 1-year follow-up were compared with the scores at discharge.  Factors related to quality of life at 1-year after discharge were analysed using univariate and multiple linear regression. Results: One hundred and ninety-seven patients were recruited, with a mean age of 62.3 years. The mean quality of life score at 1-year after discharge was significantly lower than the score at discharge. In multiple linear regression analysis, only 5 factors were associated with quality of life, including having a leisure activity, modified Barthel (Activity of Daily Living, ADL) Index (mBI) at follow-up period, need caregiver, anxiety score, and depression score with the regression coefficient (b) of 6.29 (95%CI: 2.23, 10.35), 0.63 (95%CI: 0.07, 1.20), -7.72 (95%CI: -12.04, -3.40), -0.78 (95%CI: -1.40, -0.17), and -1.14 (95% CI: -1.72, -0.57) respectively. Conclusion: At one year after discharge from inpatient rehabilitation, patients with stroke had poorer quality of life. Factors related to poor quality of life included no leisure activity, and need for caregiver, low functional scores at follow-up, anxiety and depression. Strategies to prevent these factors could enhance QoL of stroke patients

The Effectiveness and Efficiency of Inpatient Rehabilitation Services in Thailand: A Prospective Multicenter Study

Objective 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 collected. Effectiveness was defined as the difference of BI (ΔBI) and efficiency as ΔBI 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 functional rehabilitation, which was the most effective and efficient program (4.4 ± 3.6 and 0.23 ± 0.32 scores/day, respectively); the efficiency of the intensive program was not different among various diseases (P = 0.726). Conclusion Stroke rehabilitation had the highest efficiency compared with rehabilitation for other neurological diseases. The most efficient type of admission was intensive rehabilitation, regardless of the disease being treated