Effectiveness of A Newly Developed Comprehensive Rehabilitation Service Model for Subacute Stroke Patients: A Quasi-Experimental Study at A Tertiary Care Hospital in Northern Thailand

Chitchanok Ekwatthannakul; Seubtrakul Tantalanukul

Authors

Chitchanok Ekwatthannakul Physical Medicine and Rehabilitation Department, Uttaradit Hospital
Seubtrakul Tantalanukul Boromarajonani College of Nursing Uttaradit, Faculty of Nursing, Praboromarajchanok Institute, Uttaradit

Keywords:

stroke rehabilitation, subacute care, multidisciplinary care, telemedicine, caregiver training

Abstract

Objectives: To evaluate the effectiveness of a newly developed comprehensive rehabilitation service model for patients with subacute stroke at a tertiary care hospital in Northern Thailand

Study design: A quasi-experimental study with pretest-posttest control group design

Setting: Department of Rehabilitation Medicine, Uttaradit Hospital, a 680-bed tertiary care hospital serving as a regional referral center in Northern Thailand

Subjects: One hundred and fifty-four patients (77 per group) with first-ever stroke, aged 18-80 years, admitted 2-6 weeks post-onset between January and December 2021, with Modified Rankin Scale scores 2-4

Methods: The intervention group received a 12-week comprehensive rehabilitation program including (1) intensive, multidisciplinary rehabilitation (3 hours/day, 5 days/week), (2) structured caregiver education and training, (3) technology-assisted home-based rehabilitation with telemedicine support, (4) regular multi-disciplinary team review and care plan adjustment. The control group received standard rehabilitation care. The primary outcome measure was Barthel Index (BI) score. Secondary outcome measures included the Stroke Impact Scale (SIS), Hospital Anxiety and Depression Scale (HADS), EuroQol 5-Dimension (EQ-5D) quality of life assessment, and Modified Caregiver Strain Index (MCSI).

Results: At 12 weeks, the intervention group showed statistically significantly greater improvement in BI scores (mean difference 11.4, 95%CI: 6.8-16.0, p < 0.001), SIS scores (mean difference 15.6, 95%CI: 10.2-21.0, p < 0.001), HADS scores (mean difference -3.2, 95%CI: -4.8 to -1.6, p = 0.003), EQ-5D index (mean difference 0.15, 95%CI: 0.08-0.22, p < 0.001), MCSI scores (mean difference -6.4, 95%CI: -9.1 to -3.7, p < 0.001). These participants maintained their improvement at a 6-month follow-up.

Conclusions: The newly developed comprehensive rehabilitation service model significantly improved functional independence, quality of life, psychological well-being, and reduced caregiver burden in patients with subacute stroke compared to standard care. This model demonstrates the clinical and cost-effectiveness in a Thai healthcare setting, supporting its potential for broader implementation in similar settings.

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