PROGNOSIS OF DISABILITIES AND MAIN TRENDS OF REHABILITATION
Semenova A.I., Zoloyev G.K., Uchitel Y.M., Uchitel S.Y., Muflichunova N.G., Khvostava L.A., (Municipal Employment Service, Rehabilitation Centre, Novokuznetsk, Russia)
Structure and dynamics of disabilities in various age groups of the disables population of the highly industrialized city, Novokuznetsk located in Siberia region were studied. The perspective rehabilitation trends were determined taking into account prognosed changes in disability structures. In particular, vocational guidance and vocational training as well as arrangement of working places for the disabled people are of great importance equally with medical rehabilitation. Moreover, it is of particular necessity to develop municipal legal base that may allow to raise competitiveness of the disabled people in the employment market.
A STUDY OF FACTORS INFLUENCING ON DETERMINATION OF DISCHARGE DISPOSITION OF STROKE REHABILITATION PATIENTS
Katsunori Kondo (Funabashi Futawa Hospital, Funabashi, Japan)
Purpose: This study was carried out to reveal medical and socioeconomical factors which influence on determination of discharge disposition of stroke patients from a stroke unit in a community hospital.
Method: We investigated 126 stroke patients, mean age 65.9±13.9 (sd) years old, 89 infarctions and 37 hemorrhages, who were admitted within 30 days from the onset and stayed more than 30 days (mean length of stay: 79.7±45.1 days). Our rehabilitation team consists of doctors, nurses, physical therapists, occupational therapists and a medical social worker. We accepted the stroke patients from the admission and tried to begin rehabilitation approaches as soon as possible. Following 8 factors, which may affect on the determination of the discharge disposition, were analyzed using a model of multilevel logistic regression; age (22-89), sex (male or female), diagnosis (infarction or hemorrhage), severity of leg paralysis (1-4 stages) and Barthel index (0-20) at discharge, recipient of livelihood protection or not, number of family members (1-12), substantial care ability of the family based on the number of care givers (1-6 stages).
Result: (1) Ninety-eight patients (77.8%) could return to home and 28 patients were discharge to another hospital or a long term care facility. (2) Three factors, higher Barthel index (odds ratio: 1.36), more number of family members (1.84), and better substantial care ability (1.94), facilitate discharge to home. (3) Other 2 factors, hemorrhage (0.39) and recipients of livelihood protection (0.04) suppress discharge to home.
Conclusion: It is suggested that stroke unit could accelerate discharge to home by the effort to improve Barthel index. Because the socioeconomic factors also have a great influence on the determination of the discharge disposition, we should consider enough these factors.