Effectiveness of Stroke Rehabilitation Compared between Intensive and Nonintensive Rehabilitation Protocol: A Multicenter Study.

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.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.

OBJECTIVE: To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS: 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS: 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION: C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.

Health related quality of life among the Thai people with unilateral lower limb amputation.

OBJECTIVE: To study the health related quality of life (HRQOL) among Thai unilateral lower limb amputees and determine the factors associated with a good HRQOL. MATERIAL AND METHOD: A postal survey with the WHOQOL-BREF-Thai questionnaire (26 items) to 1300 people with LLA who received a lower limb prostheses from Siriraj Hospital, Prapokklao Hospital, and Ratchaburi Hospital between 2001 and 2005 was conducted. Descriptive statistics were used to report the level of HRQOL. Chi-Square, independent Sample t-test and multivariate analysis by stepwise logistic regression were used to determine the factors associated with a good QOL. RESULTS: Three hundred and nine questionnaires were completed from the 321 returned questionnaires (response rate 24.7%). Among these, 278 people were with unilateral LLA. They were 221 males and 57 females with mean age 46.9 +/- 13.9 years old. The number of people with LLA who had poor, fair and good QOL were 14 (5%), 241 (86.7%), and 23 (8.3%), respectively. Demographically, the people with LLA who had long duration of amputation (p = 0.001), higher education (p = 0.005), and had been employed after amputation (p < 0.001) had significantly better HRQOL. The amputees who had good wearing comfort (p = 0.04) after wearing the prostheses, had no phantom pain (p = 0.02), used no gait aids (p = 0.01), and had no body image anxiety (p = 0.01) had significantly better HRQOL. The factors associated with the good HRQOL were higher education (OR 3.2), having been employed after amputation (OR 2.1), and having good prosthetic wearing comfort (OR 1.3). CONCLUSION: Thai people with unilateral LLA reported primarily fair HRQOL. Having higher education, having been employed after amputation, and having good prosthetic wearing comfort were associated with the good HRQL.