Impact of inpatient rehabilitation on the quality of life of neurological patients in Thailand: A prospective multicenter cohort study

Abstract

Background: Patients with neurological diseases often have residual neurological deficits that can make self-care and ambulation functions difficult, and these obstacles to independence can have an adverse effect on QoL. Many studies have investigated patient QoL in one type of condition. However, data relating to patient QoL in rehabilitation units that treat a spectrum of disorders are scarce. Accordingly, our aim was to investigate the impact of inpatient rehabilitation on the QoL of neurological patients in Thailand, and to identify factors significantly associated with patient QoL. Methods: A prospective multicenter cohort study was performed among neurological patients receiving rehabilitation program at 14 tertiary centers during January-December 2012. The Thai Euro QoL five dimensions with three levels (Thai EQ-5D-3L) was used to evaluate the patient’s QoL twice, at admission and discharge. It consists of five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with 3 response options for each dimension: no problems, some problems, and extreme problems. Factors related to QoL were analyzed using multiple logistic regression analysis.Results: Of the 1,197 recruited patients, 567 had spinal cord injury (SCI), 561 had stroke, and 69 had traumatic brain injury (TBI). The mean age was 52.3±17.5 years, and 67.4% were male. Over half (58.0%) of patients were admitted for intensive rehabilitation program, and 17.5% were admitted for investigation. The median QoL score was significantly higher at discharge than at admission, and most subjects (59.6%) had improved QoL during the rehabilitation period. Multivariate analysis revealed onset to admission interval (OAI) less than 3 months (p<0.001) and intensive rehabilitation program (p=0.005) to be significantly associated with improved QoL. The change in QoL score was greater in the stroke group than in the SCI and TBI groups. At admission, QoL in the intensive group was below zero compared to the non-intensive group; however, the change in QoL score at discharge was greater in the intensive group.Conclusions: Inpatient rehabilitation does improve QoL of neurological patients especially participants whose onset of less than 3 months and who are ready for intensive program. Patients with potential for rehabilitation should be admitted during 3 months after onset.