三级医院短期住院卒中康复项目的结局：一项试点研究。

Suksathien Rachawan, Chaiyaphan Yaowaluk, Roongyoosiri Chantana, Muangkham Phuwadol

J Med Assoc Thai. 2015 Nov;98(11):1139-44.

BACKGROUND

Stroke is one of the most common cause of disabilities in Thailand. Full-course comprehensive rehabilitation to achieve maximum goalfor each patient was uncommon in secondary and tertiary hospitals because of limited resources and budget, so short-course inpatient stroke rehabilitation program was developed for service in these circumstances.

OBJECTIVE

To evaluate the efficiency and cost of the short-course inpatient stroke rehabilitation in Maharat Nakhon Ratchasima Hospital.

MATERIAL AND METHOD

This prospective study included stroke patients with aged over 18 years old, able tofollow one-step command and admitted in rehabilitation ward for short-course rehabilitation program between January 1 and December 31, 2014. Patient's characteristic data, Barthel Index (BI) scores, BI effectiveness, BI efficiency, length of stay (LOS), Thai HospitalAnxiety and Depression Scale (THAI HADS), WHOQOL-BREF-THAI, cost, and details oftraining were recorded

RESULTS

Fifty stroke patients were included in the present study. The mean interval from onset of stroke to admission for this program was 29.9 days (1-143, SD 31.18). The mean age was 57 years (19-86, SD 12.7). Seventy-two percent of cases were ischemic stroke. The impairments of the patients were hemiparesis (100%), aphasia (36%), dysarthria (32%), incontinence (14%), cognitive problem or neglect (12%), and dysphagia (10%). The mean LOS was 9.38 days (3-27, SD 5.31). Mean BI score on admission and at discharge were 8.12 (0-18, SD 4.52) and 13.12 (2-20, SD 4.28). The mean of BI score change was 5 (2-10, SD 2.25): The BI efficiency was 0.56 points/day. Eight cases (22%) had anxiety and 10 cases (28%) had depression. The mean total cost was 7,729 baht (1,828-22,450, SD 4,330) or about 240 US dollar

CONCLUSION

The short-course inpatient rehabilitation program could improve functional ability in stroke patients with low cost but high efficiency. This program is suitable for subacute stroke patients in hospitals with limited resources and budget.

背景

中风是泰国最常见的致残原因之一。由于资源和预算有限，在二级和三级医院中，为每个患者实现最大康复目标的全程综合康复并不常见，因此制定了短期住院中风康复计划以在这些情况下提供服务。

目的

评估玛哈叻呵叻府医院短期住院中风康复的效率和成本。

材料与方法

这项前瞻性研究纳入了年龄超过18岁、能够听从一步指令并于2014年1月1日至12月31日期间入住康复病房接受短期康复计划的中风患者。记录患者的特征数据、巴氏指数（BI）评分、BI有效性、BI效率、住院时间（LOS）、泰国医院焦虑抑郁量表（THAI HADS）、世界卫生组织生活质量简表-泰国版（WHOQOL-BREF-THAI）、成本以及培训细节。

结果

本研究纳入了50例中风患者。从中风发作到参加该计划入院的平均间隔时间为29.9天（1 - 143天，标准差31.18）。平均年龄为57岁（19 - 86岁，标准差12.7）。72%的病例为缺血性中风。患者的损伤情况为偏瘫（100%）、失语（36%）、构音障碍（32%）、失禁（14%）、认知问题或忽视（12%）以及吞咽困难（10%）。平均住院时间为9.38天（3 - 27天，标准差5.31）。入院时和出院时的平均BI评分分别为8.12（0 - 18，标准差4.52）和13.12（2 - 20，标准差4.28）。BI评分的平均变化为5分（2 - 10分，标准差2.25）：BI效率为0.56分/天。8例（22%）有焦虑，10例（28%）有抑郁。平均总成本为7729泰铢（1828 - 22450泰铢，标准差4330），约合240美元。