Clinical factors related to good functional outcome of patients in intermediate care program in Chiangrai province
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Abstract
Background: Due to inadequate inpatient beds and limited length of stay for stroke patients at Chiangrai Prachanukroh Hospital, the intermediate wards were initiated in community hospitals. Determining clinical factors related to good functional outcomes will guide the selection of suitable patients to refer to receive further care in intermediate wards in order to maximize the benefits of admitting to intermediate wards.
Objective: To evaluate clinical factors which are related to good functional outcome of Barthel index (BI) score in stroke patients in the intermediate care program
Methods: This was a retrospective cohort study. We collected the data from electronic medical records from January 2021 to August 2022. The patients were divided into two groups by BI score at 6 months after the intermediate rehabilitation program, which were good functional outcome group (BI>18) and poor functional outcome group (BI<9). The demographic and clinical data were recorded. The data were analyzed by t-test, rank sum test, exact probability test and multivariable logistic regression analysis. The statistical significance was set at p<0.05.
Results: There were a total of 240 patients (160 patients in good outcome group and 80 patients in poor outcome group). Male gender was 62.92 percent. The average age was 59.75 ±13.01 years. The significant clinical predictors of good functional outcome included age below 60 years (Adjusted OR=8.26, p=0.001), no underlying diseases of hypertension (Adjusted OR=4.32, p=0.03) or chronic kidney disease (Adjusted OR=7.96, p=0.03), no history of previous stroke (Adjusted OR=5.24, p=0.022), no complications during acute phase admission at Chaingrai Hospital (Adjusted OR=19.46, p=0.007), normal level of consciousness (Adjusted OR=6.29, p=0.048, and muscle power of the affected side of grade 3 or more before referring to a community hospital (Adjusted OR=17.31, p= <0.001).
Conclusions and Recommendations: These clinical predictors of good functional outcome in stroke patient can be utilized to select suitable patients for the intermediate ward at the community hospitals. Further studies should be done as prospective cohort studies to collect more complete data and clinical factors.
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