ผลของการพัฒนาระบบการดูแลฟื้นฟูผู้ป่วยโรคหลอดเลือดสมองระยะกลาง  โรงพยาบาลบ้านผือ จังหวัดอุดรธานี

Watcharin Inklong; Acharapan  Tongtip

Authors

Watcharin Inklong Ban Phue Hospital, Udon Thani Province
Acharapan Tongtip Ban Phue Hospital, Udon Thani Province

Abstract

Introduction: Cerebrovascular disease represents a severe chronic neurological condition necessitating comprehensive rehabilitation services for optimal recovery outcomes.

Objective: This study aimed to develop an integrated rehabilitation care system specifically designed for stroke patients during the intermediate recovery phase.

Methodology: This research and development project encompassed 43 healthcare personnel, 72 caregivers, and 72 stroke patients. Data collection instruments included patient records and performance observation checklists for both staff and caregivers. Analysis utilized descriptive statistics and paired t-tests.

Results: The rehabilitation care system comprised 13 integrated interventions: (1) airway management; (2) hygiene and bathing; (3) nutritional intake assistance; (4) oral health maintenance; (5) enteral feeding via nasogastric tube; (6) safe mobilization of debilitated patients; (7) positioning and movement therapy; (8) ambulation training; (9) stair climbing exercises; (10) pressure ulcer prevention and rehabilitation; (11) skin care protocols; (12) nutritional management; and (13) psychological support. Post-implementation findings demonstrated statistically significant improvements (p<.01) in healthcare personnel's overall practice compliance at elevated levels. Caregivers' rehabilitation capability increased significantly (p<.01). Patient outcomes showed statistically significant reductions (p<.01) in symptom severity and marked improvements (p<.01) in functional mobility capacity.

Conclusion: The structured rehabilitation care system for intermediate-phase stroke patients, when implemented with trained caregivers possessing rehabilitation competencies, produces substantial therapeutic benefits and improved patient outcomes.

Recommendations: This rehabilitation care system should be systematically and effectively implemented across healthcare settings to optimize stroke recovery and enhance long-term patient outcomes.

References

World Stroke Organization (WSO). Annual Report [Internet]. 2024 [Cited 2025 Jan 11]. Available from: https://www.Worldstroke.org/about-wso/ annual- reports

Ministry of Public Health. HDC Standard Report Group, Service Plan Information, Intermediate & Palliative Care Branch, Nonthaburi: Ministry of Public Health [Internet]. 2025 [cited 2025 February 4]. Available from: https://hdcservice.moph.go.th/hdc/reports (in Thai)

Ban Phue Hospital, Udon Thani Province. Summary report of patient situation at Ban Phue Hospital. Udon Thani: [Internet]. 2025 [Accessed 12 May 2025]. Available from: https://www.banphuehospital.com/web (in Thai)

Nukulsomprathan P. The appropriate sample size for research [Internet]. 2021 [cited 3 May 2024]. Available from: www.qualtrics.com (in Thai)

The Royal College of Physiatrists of Thailand. Development of rehabilitation care work and lessons learned from operations under the Ministry of Public Health. Working group for the rehabilitation care development project. The Royal College of Physiatrists of Thailand [Internet]. 2020 [cited 2 February 2025]. Available from:http:// rehabmed.or.th (in Thai)

Likert R. "The Method of Constructing an Attitude Scale," Reading in Attitude Theory and Measurement. edited by Martin Fishbein. New York: John Wiley & Son; 1974.

Best JW. Research in Education. Englewood Cliffs. New Jersey: Prentice Hall Inc; 1977.

Pensri L, Naksri S. Association of stroke severity and early neurological deterioration in patients with acute ischemic stroke. Thai Journal of Cardio-Thoracic Nursing 2021;32(2): 146-60. (in Thai)

Chaikeeree N, Wannapakhe J, Boonsinsukh R, Tantiwong K, Phetchatchan N, Wongkom T. Stroke Rehabilitation Assessment of Movement Thai version (STREAM-TH): Translation with reliability and concurrent validity study. SWU Physical Therapy 2018;40(1): 93-111. (in Thai)

Sumakon U, Boontad M. Development of Intermediate Care Model With Participation of Network in Sapphaya Hospital, Chainat Province. Journal of Environmental Education Medical and Health 2025;10(1): 138-47. (in Thai)

Yotnak P, Longlalerng C. Stroke Patients’ Experiences after inpatient stroke intermediate care Rehabilitation at Chiang Mai Neurological Hospital: Qualitative Research. J Raj Pracha Samasai Institute 2025;9(1): 18-29. (in Thai)

Phanchum P. Development of a model rehabilitation care for mid-term patients (Intermediate Care) Ubonratchathani Province. Journal of Health and Environmental Eucation 2024; 9(1): 309-18. (in Thai)

Siriprapapol S, Panprasert S, Didsaprae S. Development of a Care System for Hemorrhagic Stroke Patients from Hypertension at Somdetphraphutthaloetla Hospital, Thailand. Journal of Health Science 2022; 31(2): 353-64. (in Thai)

Chansri P, Samrannet W, Kor-issaranuphab N. Empowerment of caregivers for rehabilitation of stroke patients. Journal of MCU Nakhondhat. 2021;8(11):112-25. (in Thai)

Jeakpoo O. Development of an Intermediate Care Model for Stroke Patients

in Urban Areas. [A Thesis for the Degree of Master of Nursing Science]. Nonthaburi: Sukhothai Thammathirat Open University; 2021: 153 pages. (in Thai)

Bamrungthin N, Sunongbua A. EffectivenessContinuing of Care in Community among Intermediate Care ofStroke Patients, Mueang Chaiyaphum District. Chaiyaphum Medical Journal2023; 43: 59-73. (in Thai)

Katedee P, Poma A, Surawan J. Development of Intermediate care model for Stroke Inpatients with participation of caregivers and multidisciplinary team in Nam Phong Hospital Khon Kaen Province. J Environ Community Health. 2025;10(1):129-40. (in Thai)

Siriyong W. Prevalence of Stroke and Stroke Risk Factors in Kanchanadit Hospital. Reg 11 Med J 2018;32: 863-70. (in Thai)

Chitchutrakul T, Piamtem T, Maimao P. Outcomes of Rehabilitation and Factors Associated with Functional Gain in Intermediate Care of Stroke Patients, Damnoen Saduak District, Ratchaburi Province. Journal of Research for Health Improvement and Quality of Life 2024;4(1): 35-46. (in Thai)