The Effectiveness and Efficiency of Inpatient Rehabilitation Services in Thailand: A Prospective Multicenter Study

Abstract

OBJECTIVE:To investigate the effectiveness and efficiency of inpatient rehabilitation. METHODS: A total of 2,081 patients across 14 hospitals were recruited in this prospective, multicenter cohort study. Data on the diagnoses, types of admission, length of stay (LOS), and functional ability score based on a modified Barthel index (BI) at admission (BIa) and at discharge (BId) were collected. Effectiveness was defined as the difference of BI (ΔBI) and efficiency as ΔBI divided by LOS. RESULTS: The majority of patients were diagnosed with spinal cord injury and stroke (41.8% and 37.5%, respectively). The mean age was 52.4 ± 18.6 years with a mean LOS of 23.9 ± 19.9 days, BIa of 9.4 ± 6.1, and BId of 12.3 ± 5.7. The overall effectiveness and efficiency were 2.9 ± 3.4 and 0.16 ± 0.30 scores/day, respectively; stroke rehabilitation provided the most effective and efficient BI improvement compared with rehabilitation for other diseases. Most patients (54.5%) received intensive functional rehabilitation, which was the most effective and efficient program (4.4 ± 3.6 and 0.23 ± 0.32 scores/day, respectively); the efficiency of the intensive program was not different among various diseases (P = 0.726). CONCLUSION: Stroke rehabilitation had the highest efficiency compared with rehabilitation for other neurological diseases. The most efficient type of admission was intensive rehabilitation, regardless of the disease being treated.

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

“…This outcome may due to some of our patients not being ready to undertake a rehabilitation program (nonintensive goal of admission of 42.0%), and approximately 30% had complications during the rehabilitation period. 3 Moreover, almost 50% of our subjects were SCI, which is associated with complicated physical disabilities, including motor impairment, di culty with urination and defecation, and sexual dysfunction, that can adversely impact QoL [17], and some self-evaluated themselves as having poor QoL [18][19][20].…”

“…Ploypetch and Dajpratham reported improved QoL after rehabilitation in patients admitted for intensive rehabilitation [16]. In 2016, Kuptniratsaikul, et al conducted a multicenter study in 2,081 rehabilitation inpatients that revealed the most e cient type of admission to be intensive rehabilitation, which could improve functional score better than other types of admission [3]. A 2012 study showed association between better patient QoL perceptions and the level of patient independence [23].…”

“…This prospective multicenter study was a part of a Rehabilitation Services key performance indicator (KPI) project that was performed at 14 tertiary care centers with inpatient rehabilitation services that are located across Thailand [3]. Patients admitted for rehabilitation included patients with SCI, stroke, TBI, or other musculoskeletal diseases.…”

“…The types of admission included: (i) intensive rehabilitation (de ned as the patient being able to tolerate a rehabilitation program of at least 3 hours per day); (ii) less-intensive rehabilitation (de ned as the patient could tolerate a rehabilitation program of one to two hours per day); (iii) investigation(s) (de ned as a patient who requires any type of examination, such as a regular checkup of the urinary system in SCI patients); (iv) caregiver training (de ned as training for a caregiver who is responsible for providing proper care for a patient); (v) treatment of complications (de ned as a patient who requires proper care for any serious complications, such as pneumonia, pressure ulcer, or deep vein thrombosis); and, (vi) others (de ned as types of admission other than those described above) [3].…”

“…Most patients receiving inpatient rehabilitation in Thailand are neurological patients, including those with stroke, spinal cord injury (SCI), or traumatic brain injury (TBI) [3]. After admission in the rehabilitation ward, the aim is to help patients improve their mobility and their ability to perform activities of daily living (ADL).…”