Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Family Medicine

Supervisor

Amardeep Thind

2nd Supervisor

Rob Petrella

Joint Supervisor

Abstract

Post-acute rehabilitation is the active process where disabled persons realize their optimal recovery potential through therapy after discharge from acute hospital admissions. Community hospitals which are mainly run by family physicians in Singapore provide post-acute rehabilitation, and are similar to US inpatient rehabilitation facilities and Canada’s specialty rehabilitation facilities. This thesis is based on a national dataset of all admissions into community hospitals in Singapore from 1996 to 2005 (ten years) manually extracted from medical records of four sites by the PhD candidate. Four chapters are presented: (1) a systematic review of the rehabilitation indices from published studies and their reported predictors, (2) a descriptive study of community hospitals admissions in total and stratified by year of admission, (3) an analysis of the predictors of rehabilitation effectiveness (REs) and efficiency (REy) among stroke rehabilitation patients and trade-off relationships between REs and REy, and (4) the factors independently associated with caregiver availability, number of potential caregivers and primary caregiver identity among stroke rehabilitation patients. The systematic review found five main rehabilitation indices existing in literature (absolute functional gain, REs, REy, relative REs and relative REy) and strong evidence for age, pre-rehabilitation functional status and cognitive impairment as the independent predictors of REs and REy. The second study found increasing annual trends in mean age, need for subsidized beds, admission for post hip fracture arthroplasty rehabilitation, mean admission and discharge functional status, and reliance on foreign domestic worker as primary caregivers among patients admitted into community hospitals from 1996 to 2005. The third study identified new factors predictive of poorer stroke REs and REy such as female gender, minority ethnicities and caregiver availability. Trade-off relationships between REs and REy were found with respect to admission functional status and length of stay, with optimal admission Barthel Index score and length of stay to optimize REs and REy as 35 to 60 units and 37 to 41 days respectively. The fourth study found that social factors such as age, gender, religion, ethnicity and socioeconomic status of stroke rehabilitation patients affected caregiver availability, number of potential caregivers and primary caregiver identity.

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