Ismail, Nur Raihan
(2018)
Factors associated with improvement in activities of daily living (ADL) in stroke patients post domiciliary care in Kelantan.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Rehabilitation is crucial to assist individuals with stroke to improve
activities of daily living (ADL). Despite of comprehensive rehabilitation provision,
recognition of the associated factors influence stroke recovery are also important. In
Malaysia, domiciliary care service is an outreach home-based rehabilitation, provided
by a multidisciplinary rehabilitation team for stroke survivors. However, there has
been no study conducted to assess factors associated with improvement in ADL
among stroke patients after the rehabilitation service.
Objective: To describe the proportion of stroke patients with improved ADL post
domiciliary care and to determine the demographic and clinical factors associated with
the improvement in ADL among stroke patients post Domiciliary Care in Kelantan.
Methodology: This was a cross sectional study, conducted from February until April
2018 using secondary data obtained from Domiciliary Care Referral Letter,
Domiciliary Care Patient’s Record (PPD 004 (a)/2014) and Domiciliary Case
Assessment Record (PPD 004 (b)/2014) which are used as formal documentations for
the domiciliary care in Malaysia. The data from 11 health clinics with comprehensive
domiciliary care in Kelantan were collected using a proforma and analysed using IBM
SPSS Statistics version 22 software. Descriptive and multiple logistic regression
analysis were performed. Improved ADL is defined as at least 30% increment at the
end of the service.
Results: Between January 2015 and October 2017, there were 384 stroke patients
registered in comprehensive domiciliary care service for the state of Kelantan, in
which 234 individuals fulfilled the study criteria and were all included in the study.
The proportion of stroke patients with improved in ADL was found to be 72.2%, which
comprised of 96 (41.0%) of the male population and 138 (59.0%) of females. The
mean (SD) age for stroke patients were 68.21 (11.99) years old. One hundred and fifty
seven (67.1%) of stroke patients were aged 65 years and above and two third were
married (65.8%). Majority of patients had ischemic stroke. Significant association was
found between age group (Adj. OR 2.241; 95% CI 1.019, 4.927; p =0.045), ischemic
stroke type (Adj. OR 4.842; 95% CI: 2.180, 10.758; p <0.001), less severe stroke
(mRS score 4) (Adj. OR 3.492; 95% CI: 1.696, 7.189; p =0.001), no history of
previous stroke (Adj. OR 3.702; 95% CI: 1.756, 7.803; p =0.001) and those received
≥8 rehabilitation visits (Adj. OR 2.226; 95% CI: 1.113, 4.450; p =0.024).
Conclusion: The young age <65 years old, ischemic type of stroke, less severe stroke
(mRS 4), no history of previous stroke and ≥8 rehabilitation visits were found to be
significant factors associated with the improvement in ADL post stroke event.
Recognition of these factors of stroke recovery is beneficial to intensify an optimal
stroke care and rehabilitation services in the country.
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