They are trying to figure out predictive factors and someday they will figure out that first you need a damage diagnosis.
http://thailand.digitaljournals.org/index.php/SRMJ/article/viewFile/8642/8097
First three paragraphs -
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ABSTRACT
Objective: To study the factors associated with the functional improvement at discharge in stroke patients receiving inpatient rehabilitation.
Methods: Retrospective review of the medical records of all the stroke patients admitted to inpatient rehabilitation, Department of Rehabilitation Medicine, Siriraj Hospital from January 2005 to December 2005. Results: There were sixty-one stroke patients, 39 males and 22 females, with a mean age 62.5 years old. Most of them lived with their spouses (61%) and had cerebral infarction (61%). The risk factors of stroke reported were hypertension (86.9%),
dyslipidemia (63.9%), diabetes mellitus (34.4%), previous stroke (31.1%), heart disease (18%), smoking (8.2%) and regular alcoholic drinking (3.3%) respectively. The right and left side weakness were equally reported. The median duration of stroke before admission was 62 days. The disabilities at admission were urinary incontinence (39.3%), dysphagia (32.8%), and aphasia
(26.2%). During the hospital stay, the complications which occurred were shoulder problems (41%), other musculoskeletal pain (34.4%), depression (26.2%), shoulder hand syndrome (13.1%), urinary tract infection (6.6%), and pneumonia (4.9%) respectively.
Forty-seven patients (77%) gained functional improvement at discharge. The Chi-Square and Independent Sample T tests revealed the association between the functional improvement at discharge and urinary continence on admission (p=0.011), and duration of stroke within 3 months before admission to rehabilitation (p=0.011) with the odds ratio 5.9 and 5.3 respectively.
Conclusions: The functional improvement after the process of inpatient stroke rehabilitation was associated with the duration of stroke within 3 months before rehabilitation admission and urinary continence on admission.
Keywords: Discharge; factor; functional improvement; rehabilitation; stroke
Siriraj Med J 2007; 59: 222-225
E-journal: http://www.sirirajmedj.com
he goals of rehabilitation management after stroke
are to restore optimal physical and psycho-socialvocational
function to enable the patient to become
a productive participant in the community. Among these
goals, optimum physical function which means the ability
to walk and perform the normal self-care tasks is very
meaningful to the stroke patients as well as their families.
The motor and functional recovery are crucial for the
functional improvement. Naturally, the motor recovery
usually happens within the first 3-6 months after stroke1.
Meanwhile, there is established evidence that stroke
rehabilitation improves functional outcome by reducing
disability in individual patients2. However, the functional
recovery in every individual is different and is hardly
predicted. There have been a number of studies exploring
the predictive factors for functional improvement in various
stages of stroke. For example; in the acute phase, the
postadmission Barthel Index score was found to be the
best predictor of hospital length of stay, hospital charge,
discharge destination3, and three years functional outcome
after a stroke4. The urinary incontinence was the poor
prognostic factor in the subacute phase for ambulation
and activities of daily living at six months to one year
after stroke5.
The inpatient rehabilitation of the Department of
Rehabilitation Medicine admitted the stroke patients in
both acute and subacute phases. The stroke rehabilitation
process is a goal-directed treatment which focuses on
achieving specific objectives. Therefore, studying the factors
that might affect the functional improvement in this group
of patients would help the rehabilitation professionals select
the more potential candidates, formulate the realistic and
feasible goals, timely prepare for the discharge planning,
and inform the patients and their families regarding the
continuing care program.
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