Prevalence and management of poststroke spasticity in Thai stroke patients: a multicenter study.

OBJECTIVES: To study the prevalence, associated factors and management of poststroke spasticity in two muscle groups namely elbow flexor and knee flexor. MATERIAL AND METHOD: The Thai stroke rehabilitation registry (TSRR) was conducted among 9 rehabilitation centers. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. The Brunnstrom motor recovery stage, Barthel Index, Thai Mental State Examination, Modified Ashworth Scale (MAS), and WHOQOL-BREF-Thai (26 items) questionnaires were used to assess the motor recovery, functional disability, cognition, spasticity and quality of life on admission respectively. The management of spasticity was also recorded. RESULTS: There were 327 patients with a mean age of 62.2-years-old participating in the study. The prevalence of poststroke spasticity was 41.6%. Among these the prevalences of spasticity of both elbow and knee flexors was 31.2% and of either elbow or knee flexor were 4.9% and 5.5% respectively. Spasticity with MAS grade 1 was found in the majority. The patients with spasticity had a significantly longer time to rehabilitation admission interval after the stroke (p = 0.049), had the Brunnstrom motor recovery stages of arm (p < 0.001), hand (p = 0.003) and leg (p < 0.001) significantly lower than the no spasticity group. The factor associated with spasticity was Brunnstrom motor recovery stage 2 and 3 of the arm with the odds ratio being 6.1 (95% CI = 2.5-14.9) and 3.5 respectively (95% CI = 1.3-9.2). Management of spasticity was demonstrated in 83 patients (25.4%). Therapeutic exercise, oral antispastic medication and assistive device were the first three managements frequently prescribed respectively. CONCLUSION: Spasticity was a common complication after stroke. Although the prevalence was quite high, spasticity with MAS grade 1 was found in the majority of cases. The associated factor was the Brunnstrom motor recovery stage of the arm. Therapeutic exercise was the mainstay of the management.

Inpatient rehabilitation services for patients after stroke in Thailand: a multi-centre study.

OBJECTIVE: To set a baseline for measuring the development of medical rehabilitation services and outcomes for patients after stroke and promoting rehabilitation medicine in Thailand. DESIGN: Multi-centre, prospective study. SUBJECTS: Patients after stroke in Thai Stroke Rehabilitation Registry (TSRR), aged > or = 18 years, with stable medical signs, able to follow a 1-step command and sit for at least 30 min. METHODS: Rehabilitation services were recorded daily as units of treatment (1 unit = 20 min). Length of stay and treatment costs were calculated. RESULTS: Of 327 patients enrolled in the study, 285 (87.2%) completed their treatment programme. Mean length of stay was 29.4 (standard deviation 17.9) days. The average number of total treatment units for stroke rehabilitation was 319.5 (range 27-1674 units), with 205 units of nursing, 40 units of physical therapy and 34 units of occupational therapy as the top 3 services provided. The mean total cost for all treatments during rehabilitation was 28,399 (standard deviation 22,511) baht (approximately USD 789). The ratio of costs not related to rehabilitation to those related to rehabilitation was approximately 2:1. CONCLUSION: This study reports the baseline for measuring the development of rehabilitation services for patients after stroke with a mean length of stay of one month, and for estimating the reasonable costs.

Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study.

OBJECTIVE: To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify factors associated to these conditions during rehabilitation period. MATERIAL AND METHOD: Stroke patients from 9 rehabilitation centers from March to December 2006 were enrolled in the present study. All subjects were registered for demographic data including risk factors and type of stroke. They were assessed for motor recovery, cognitive ability, functional ability, psychological reaction and quality of life by using Brunnstrom stage, Thai Mental State Examination (TMSE), Barthel ADL Index (BI), Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF questionnaires respectively at the beginning and the end of the present study. The occurence of shoulder subluxation and shoulder pain were recorded and then were analyzed for the associated factors. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Of 376 stroke patients, 327 met the inclusion criteria, 62 patients (19%) were found to have shoulder pain and 122 (37%) patients had shoulder subluxation. Shoulder pain was significantly more frequent in subjects with shoulder subluxation (odds ratio (OR) 2.48, 95% confidence interval (CI) 1.38-4.46) and at 2-6 months after stroke onset (OR 4.0, 95% CI 2.06-7.79). Shoulder subluxation was significantly associated with hemorrhagic type of stroke (OR 2.06, 95% CI 1.08-3.93), loss of proprioceptive sensation (OR 3.03, 95% CI 1.26-7.29) and negatively associated with Brunnstrom's stage of arm recovery (OR 0.44, 95% CI 0.34-0.56). No significant functional and quality of life impact was found from these conditions. CONCLUSION: Post stroke shoulder pain and subluxation were common during the rehabilitation period. Shoulder pain significantly occurred within 6 months after stroke onset and increased risk in patients with shoulder subluxation. Shoulder subluxation was correlated with Brunnstrom's stage, proprioceptive loss and hemorrhagic type of stroke.