Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, March 3, 2026

Determinants of Rehabilitation Follow-up Non-adherence among Stroke Patients in Sibu, Sarawak

 

You're that fucking clueless that you UNDERSTAND NOTHING ABOUT SURVIVOR MOTIVATION! My god, I'd have you all fired for stupidity!

My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION/DEMORALIZATION, DO YOU? You create EXACT 100% recovery protocols, and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. I'd fire all of you for absurd incompetence! GET THERE!

Here's my email: oc1dean@gmail.com Tell me EXACTLY where I'm wrong! Difficulty in getting to those protocols will not be tolerated as an excuse. You've known of this problem of 100% recovery since your education, so you've had years if not decades to work on it! Comeuppance is going to be a bitch when you are the 1 in 4 per WHO that has a stroke? Then you just might want 100% recovery. Or you can be like me where half my life will be disabled!

Determinants of Rehabilitation Follow-up Non-adherence among Stroke Patients in Sibu, Sarawak

Nurul Raihana Rahim
Rou Chen Jee

Abstract

Background: 
Sarawak’s vast geography, with remote communities and limited transport infrastructure, poses significant challenges for stroke rehabilitation, yet data on patient attrition in rural Borneo remain limited. This study aimed to evaluate the characteristics of stroke survivors referred for rehabilitation at Hospital Sibu and to identify independent predictors of non-adherence at follow-up.

Methods: 

Inpatient referrals to the Rehabilitation Medicine Department at Hospital Sibu between February 2022 and December 2024 were retrospectively analysed. To avoid competing risk bias, patients who died before their first follow-up were excluded. Factors associated with non-adherence, including functional status, socioeconomic background and travel time, were examined using multivariable binary logistic regression.


Results: 

The analytic cohort comprised 631 survivors (mean age 56.7 ± 15.1 years). Overall, 50.4% (n = 318) defaulted on their first outpatient appointment. Multivariable analysis identified travel time as the dominant barrier: patients living > 30 minutes from the hospital had a 40-fold higher risk of default (adjusted odds ratio [aOR] = 39.81; 95% confidence interval [CI]: 22.46, 70.58; P < 0.001). Functional dependency also predicted attrition (aOR = 0.98 per Modified Barthel Index point; P < 0.001). Ethnic disparities emerged after adjusting for geography: Chinese ethnicity was associated with lower default risk (aOR = 0.63; P = 0.028), while Melanau ethnicity remained strongly protective (aOR = 0.35; P = 0.001).


Conclusion: 

Post-stroke rehabilitation attrition in central Sarawak is high (50%). Although functional dependency and ethnicity were significant predictors, geographical inaccessibility is the primary driver of non-adherence. Decentralising care is critical to overcoming this logistical barrier.

Article Details

How to Cite
Rahim NR, Jee RC. Determinants of Rehabilitation Follow-up Non-adherence among Stroke Patients in Sibu, Sarawak. Malays J Med Sci [Internet]. 2026 Feb. 28 [cited 2026 Mar. 4];33(1). Available from: https://ejournal.usm.my/mjms/article/view/mjms_vol33-no1-2026_8

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