รายงานเบื้องต้นผลลัพธ์การบริการฟื้นสภาพแบบผู้ป่วยในจากสถานพยาบาลระดับตติยภูมิในโครงการทะเบียนโรคบาดเจ็บไขสันหลังไทย
รายงานเบื้องต้นผลลัพธ์การบริการฟื้นสภาพแบบผู้ป่วยในจากสถานพยาบาลระดับตติยภูมิในโครงการทะเบียนโรคบาดเจ็บไขสันหลังไทย
Keywords:
spinal cord injury, inpatient rehabilitation services, rehabilitation outcomes, complications, epidemiologyAbstract
Objectives: To report preliminary outcomes of inpatient rehabilitation services for spinal cord injury (SCI) patients in the Thai SCI registry (TSCIR) project.
Study design: A prospective and descriptive study.
Setting: Rehabilitation wards at Maharaj Nakorn Chiang Mai Hospital, Sirindhorn National Medical Rehabilitation Institute, Ratchaburi Hospital and Siriraj Hospital.
Subjects: Traumatic SCI (TSCI) and non-traumatic SCI (NTSCI) patients admitted for the first time for inpatient medical rehabilitation services from February 2015 to April 2016.
Methods: Rehabilitation outcomes were extracted from medical records. Demographic data and injury data based on the International SCI (ISCI) core data set, the traumatic data set, the non-traumatic SCI data set whereas the rehab outcomes such as the ASIA impairment scale (AIS), rehab length of stay (LOS), the spinal cord independence measure (SCIM), patients’ satisfaction with their rehab outcomes, were analyzed and compared between the TSCI and the NTSCI groups.
Results: Of 122 patients, 87 were TSCI and 35 were NTSCI patients. The most common causes of TSCI were road traffic crashes (55%) whereas of NTSCI were vertebral column degenerative disorders (31.4%). When comparing between the TSCI and the NTSCI groups, 75% and 34% were males, the median age at onset were 44 and 52 years, 81% and 51% were surgically treated; 34.9% and 43% were classified as AIS-D at admission, and 43% and 64% at discharge; the median rehab LOS was 28 and 24 days, and the median SCIM gain was 19 and 20, respectively. The TSCI group had higher complication rates than NTSCI (41.5% and 24.2%). The median scores of patients’ satisfaction with the rehab outcomes were equal (10 out of 10).
Conclusion: More than two-thirds of the SCI patients admitted for inpatient medical rehabilitation services were traumatic cases. The traumatic group had more males, lower age at onset, higher rates of surgery and complications, longer length of stay than the non-traumatic group but similar functional gain and high satisfaction with rehab outcomes.
References
2. World Health Organization. International perspectives on spinal cord injury. Geneva: WHO, 2013.
3. Loharjun B. Summary of rehabilitation 2030: a call for action. J Thai Rehabil Med. 2017; 27:1-3.
4. Kuptniratsaikul V, Wattanapan P, Wathandilokul U, Sukonthamarn K, Lukkanapichochut P, Ingkasuthi K et al. The effectiveness and efficiency of inpatient rehabilitation services in Thailand: a prospec-tive multicentre study. Rehabil Proc Outcome. 2016;5:13-18.
5. Kovindha A. People with spinal cord injury in Thailand. Am J Phys Med Rehabil. 2017;96(2 Suppl):S120-3.
6. National Health Security Office. Disease related grouping (DRG) version 5.0, B.E. 2554.
7. Khiaocharoen O, Pannarunothai S, Riwepaiboon W, Zungsontiporn C. Rehabilitation service development for sub-acute and non-acute patients under the universal coverage scheme in Thailand. J Health Sci. 2015;24:493-509.
8. Sakunphanit T, Wongsin U, Labbenchakul S. Unit cost for long term care: Lomsonti district. Nonthaburi: Health insurance system research office. [cited 2017 August 30]. Available from: https://www.slideshare.net/utoompornwongsin/estimating-cost-of-long-term-care.
9. DeVivo M, Biering-Sørensen F, Charlifue S, Noonan V, Post M, Stripling T, et al. International spinal cord injury core data set. Spinal
Cord. 2006;44:535-40.
10. New PW, Marshall R. International spinal cord injury data sets for non-traumatic spinal cord injury. Spinal Cord. 2014;52:123-32.
11. Catz A, Itzkovich M, Tesio L, Biering-Sørensen F, Weeks C, Laramee MT, et al. A multicentre international study on the spinal cord independence measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45:275-91.
12. Ditunno JF Jr, Ditunno PL, Scivoletto G, Patrick M, Dijkers M, Barbeau H, et al. The walking index for spinal cord injury (WISCI/WISCI II): nature, metric properties, use and misuse. Spinal Cord. 2013;51:346-55.
13. Charlifue S, Post MW, Biering-Sørensen F, Catz A, Dijkers M, Geyh S, et al. International spinal cord injury quality of life basic data set. Spinal Cord. 2012;50:672-5.
14. Pajareya K. Truamatic spinal cord injuries in Thailand: an epidemiologic study in Siriraj Hospital, 1989-1994. Spinal Cord. 1996;34: 608-10.
15. Kuptniratsaikul V. Epidemiology of spinal cord injuries: a study in the spinal unit, Siriraj Hospital, Thailand, 1997-2000. J Med Assoc Thai. 2003;86:1116-21.
16. Arora M, Chhabra HS, Kovindha A, Hasnan N. Patients with spinal cord injury in South East Asia region: epidemiology based on the International Spinal Cord (ISCOS) data set. the 9th ASCON Annual Scientific Meeting; 2010 31th October; Le Meridien Hotel, New Delhi, India. 2010.
17. Kovindha A. 5th September: SCI day. J Thai Rehabil Med. 2017;27: 39.
18. Khiaocharoen O, Pannarunothai S, Zungsontiporn C, Riewpaiboon W. Casemix classification payment for sub-acute and non-acute inpatient care, Thailand. J Med Assoc Thai. 2010;93:849-59.
