Functional recovery in the immediate post stroke period predicts the long-term prognosis of post stroke patients. Despite the advancement in stroke rehabilitation in improving the physical function of survivors, there are other factors that may influence functional recovery. We aimed to assess the functional recovery of ischaemic stroke patients attending a tertiary hospital and its associated factors in order to make recommendations for post stroke care after hospital admission. A three months prospective observational study looking at functional recovery using the Modified Barthel’s Index (MBI) and depression (Patient Heath Questionnaire-9) score of post stroke patients. There were 46 ischaemic stroke patients who were recruited for the study. At three months, only 37 patients were eligible for analysis. The mean age was 67.2 (SD 11) years with the Malays (50%) making up the majority of the patients, followed by Chinese (41.3%) and Indians (8.7%). There was a total of seven (15.2%) deaths. Hypertension was the most common risk factor (89.1%) followed by dyslipidaemia (65.2%) and diabetes mellitus (63.0%). The mean MBI difference was 45.2 (SD 27.0) with a median MBI of 17.0(IQR 33.0) at baseline compared to 85.0(IQR 42.0) at three months (p < 0.001, CI 35.98,55.45). The prevalence of depression (PHQ-9≥10) was 21.6%. Lower functional recovery was found among depressed patients (p <0.026) and among patients with recurrent stroke (p< 0.035). Significant functional recovery can be seen as early as three-months post stroke. Factors such as recurrent stroke and depression may affect functional recovery post stroke; hence should be routinely screened.
Prospective Study of Functional Recovery of Stroke Patients at Three Months Post Admission: Outcomes and Implications for Post Stroke Care Provision
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Abstrak
Pemulihan fungsi fizikal pesakit selepas strok boleh menentukan prognosis jangka masa panjang mereka. Selain kaedah rehabilitasi, terdapat faktor-faktor lain yang boleh mempengaruhi tahap pemulihan ini. Kami menilai tahap pemulihan fizikal jangka pendek pesakit strok iskemik yang mendapat rawatan di hospital tertier serta faktor-faktor yang mempengaruhinya. Ini dapat mengesyorkan rawatan lanjut strok selepas kemasukan hospital. Kajian pemerhatian dijalankan selama tiga bulan. Indeks Bathel yang telah diubah suai (MBI) digunakan untuk menilai tahap fungsi fizikal dan kertas soal selidik “Patient Health Questionnaire-9” (PHQ-9) untuk mengesan tahap kemurungan pesakit pasca strok. Sejumlah 46 pesakit strok terlibat di dalam kajian ini. Walaubagaimanapun, hanya 37 pesakit berjaya mendapat pemeriksaan susulan dan dianalisa. Purata umur bagi pesakit adalah 67.2 (±11) tahun. Melayu merupakan kaum majority (50%) diikuti dengan kaum Cina (41.3%) dan India (8.7%). Tekanan darah tinggi adalah faktor risiko paling tinggi (89.1%) diikuti dengan masalah kolesterol (65.2%) dan diabetis (63.0%). Purata kadar perbezaan MBI ialah 45.2 (SD 27.0) dengan median MBI 17.0 (IQR 33.0) pada permulaan kajian dibandingkan dengan 85.0 (IQR 42.0) selepas tiga bulan (p<0.001,CI 35.98,55.45). Prevalen kemurungan selepas strok (PHQ-9≥10) adalah sebanyak 21.6%. Kami mendapati bahawa pesakit yang mempunyai kemurungan pada masa tiga bulan dan mereka yang pernah mengalami strok sebelum ini mempunyai pemulihan fungsi yang lebih rendah (p<0.035). Pemulihan yang nyata dari segi fungsi fizikal telah ditunjukkan oleh pesakit strok dalam tempoh tiga bulan pertama selepas strok. Faktor seperti kemurungan dan pernah mengalami strok boleh mempengaruhi kadar pemulihan, oleh itu perlu untuk di saring pada peringkat awal.
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