Long-term morbidities in stroke survivors: a prospective multicenter study of Thai stroke rehabilitation registry

BMC Geriatrics

Yingsumal Archongka²  Nuttaset Manimmanakorn⁴  Sumalee Suethanapornkul⁵  Apichana Kovindha¹  Vilai Kuptniratsaikul³ 

[1] Rehabilitation Medicine Department, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;Sirindhorn National Medical Rehabilitation Center, Department of Medical Service, Ministry of Public Health, Nonthaburi, Thailand;Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkok, 10700, Thailand;Rehabilitation Medicine Department, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand;Rehabilitation Medicine Department, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

关键词: Depression;    Pain;    Multi-center study;    Registry;    Morbidity;    Stroke;   

Others  :  857791
DOI  :  10.1186/1471-2318-13-33

 received in 2012-12-10, accepted in 2013-04-05,  发布年份 2013

【 摘 要 】

Background

Stroke-related complications are barriers to patients’ recovery leading to increasing morbidity, mortality, and health care costs, decreasing patient’s quality of life. The purpose of this study was to quantify incidence and risk factors of stroke-related complications during the first year after discharge from rehabilitation ward.

Methods

A prospective observational study was conducted in nine tertiary-care rehabilitation centers. We evaluated the incidence of morbidities during the first year after stroke, including musculoskeletal pain, neuropathic pain, pneumonia, deep vein thrombosis (DVT), pressure ulcer, spasticity, shoulder subluxation, joint contracture, dysphagia, urinary incontinence, anxiety and depression. The complications at discharge and at month-12 were compared using the McNemar test. Univariate analysis and multiple logistic regression analysis by forward stepwise method were used to determine factors predicting the complications at month-12.

Results

Two hundred and fourteen from 327 patients (65.4%) were included. The age was 62.1 ± 12.5 years, and 57.9% were male. In 76.8% of the patients at least one complication was found during the first year after stroke. Those complications were musculoskeletal pain (50.7%), shoulder subluxation (29.3%), depression (21.2%), spasticity (18.3%), joint contracture (15.7%) and urinary incontinence (14.4%). Other complications less than 5% were dysphagia (3.5%), pressure ulcer (2.6%), infection (1.5%), and neuropathic pain (3.0%). Nearly 60% of patients with complications at discharge still had the same complaints after one year. Only 7.6% were without any complication. Morbidity was significantly associated with age and type of stroke. Using multiple logistic regression analysis, age and physical complications at discharge were significant risk factors for physical and psychological morbidities after stroke respectively (OR = 2.1, 95% CI 1.2, 3.7; OR = 3.1, 95% CI 1.3, 7.1).

Conclusion

Long-term complications are common in stroke survivors. More than three-fourths of the patients developed at least one during the first year after rehabilitation. Strategies to prevent complications should be concerned especially on musculoskeletal pain which was the most common complaint. Physical complications at discharge period associated with psychological complications at 1 year followed up. More attention should be emphasized on patients age older than 60 years who were the major risk group for developing such complications.

【 授权许可】

   
2013 Kuptniratsaikul et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Shah MV: Rehabilitation of the older adult with stroke. Clin Geriatr Med 2006, 22:469-489.
• [2]Karges J, Smallfied S: A description of the outcomes, frequency, duration, and intensity of occupational, physical, and speech therapy in inpatient stroke rehabilitation. J Allied Health 2009, 38:E1-E10.
• [3]Doshi VS, Say JH, Young SH, Doraisamy P: Complications in stroke patients: a study carried out at the rehabilitation medicine service, changi general hospital. Singapore Med J 2003, 44:643-652.
• [4]Dromerick A, Reding M: Medical and neurological complications during inpatient stroke rehabilitation. Stroke 1994, 25:358-361.
• [5]Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y: Complications during the rehabilitation period in Thai patients with stroke: a multicenter prospective study. Am J Phys Med Rehabil 2009, 88:92-99.
• [6]Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S: Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke 2001, 32:523-529.
• [7]Domka E, Myjkowska E, Kwolek A: Incidence of neuromedical complications during rehabilitation after stroke. Neurol Neurochir Pol 2005, 39:300-309.
• [8]Johnston KC, Li JY, Lyden PD, Hanson SK, Feasby TE, Adams RJ, Faught RE Jr, Haley EC Jr: Medical and neurological complications of ischemic stroke: experience from the RANTTAS trial. Stroke 1999, 29:447-453.
• [9]Kuptniratsaikul V, Kovindha A, Massakulpan P, Piravej K, Suethanapornkul S, Dajpratham P, Manimmanakorn N, Permsirivanich W, Archongka Y, Kuptniratsaikul PS: An epidemiologic study of the Thai stroke rehabilitation registry (TSRR): a multi-center study. J Med Assoc Thai 2008, 91:225-233.
• [10]Mahoney FI, Barthel DW: Functional evaluation: the barthel index. Md State Med J 1965, 14:61-65.
• [11]Barczak CA, Barnett RI, Childs EJ, Bosley LM: Fourth national pressure ulcer prevalence survey. Adv Wound Care 1997, 10:18-26.
• [12]Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987, 67:206-207.
• [13]World Health Organization: International classification of functioning, disability and health. Geneva: World Health Organization; 2001.
• [14]Nilchaikovit T, Lotrakul M, Phisansuthideth U: Development of Thai version of hospital anxiety and depression scale in cancer patients. J Psychiatr Assoc Thai 1996, 41:18-30.
• [15]Kuptniratsaikul V, Kovindha A, Piravej K, Dajpratham P: A 1-year follow-up of outcomes after stroke rehabilitation: a multi-center study. Biomed Res Intin press
• [16]Pinedo S, de la Villa FM: Complications in the hemiplegic patient in the first year after the stroke. Rev Neurol 2001, 32:206-9.
• [17]Sackley C, Brittle N, Patel S, Ellins J, Scott M, Wright C, Dewey ME: The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke 2008, 39:3329-34.
• [18]Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS: Pain following stroke: a prospective study. Eur J Pain 2012, 16:1128-36.
• [19]Lindgren I, Jönsson AC, Norrving B, Lindgren A: Shoulder pain after stroke: a prospective population-based study. Stroke 2007, 38:343-8.
• [20]Kocabas H, Levendoglu F, Ozerbil OM, Yuruten B: Complex regional pain syndrome in stroke patients. Int J Rehabil Res 2007, 30:33-8.
• [21]Paci M, Nannetti L, Taiti P, Baccini M, Rinaldi L: Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiother Res Int 2007, 12:95-104.
• [22]Panel O, Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J: Ottawa panel evidence-based clinical practice guidelines for post-stroke rehabilitation. Top Stroke Rehabil 2006, 13:1-269.
• [23]Koyuncu E, Nakipoğlu-Yüzer GF, Doğan A, Ozgirgin N: The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: a randomized controlled trial. Disabil Rehabil 2010, 32:560-6.
• [24]Paci M, Nannetti L, Rinaldi LA: Glenohumeral subluxation in hemiplegia: an overview. J Rehabil Res Dev 2005, 42:557-68.
• [25]Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, Dick F, Taylor GS, Murray G: Medical complications after stroke: a multicenter study. Stroke 2000, 31:1223-9.
• [26]Khan M, Ahmed B, Ahmed M, Najeeb M, Raza E, Khan F, Moin A, Shujaat D, Arshad A, Kamal AK: Functional, cognitive and psychological outcomes, and recurrent vascular events in Pakistani stroke survivors: a cross sectional study. BMC Res Notes 2012, 5:89-96. BioMed Central Full Text
• [27]Lee CD, Folsom AR, Blair SN: Physical activity and stroke risk: a meta-analysis. Stroke 2003, 34:2475-81.
• [28]Kauhanen M, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Määttä R, Nieminen P, Sotaniemi KA, Myllylä VV: Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999, 30:1875-80.