Medical complications during inpatient stroke rehabilitation in Thailand: a prospective study.

OBJECTIVE To identify the incidence and risk factors of medical complications during inpatient stroke rehabilitation. MATERIAL AND METHOD Stroke patients (n = 118) admitted to the Thai Red Cross Rehabilitation Center between August 2006 and January 2007 were prospectively evaluated throughout inpatient rehabilitation to identify incidence of complications. RESULTS Eighty-three patients (70.3%) experienced at least one complication. The common complications were post-stroke depression (56.6%), musculoskeletal pain (28%), urinary tract infection (UTI) (17.8%), and complex regional pain syndrome (CRPS) type I (15.3%). Others were pneumonia (4.2%), cardiovascular complications (4.2%), falls (4.2%), upper GI bleeding (3.2%), seizure (2.5%), and pressure ulcer (1.7%). Fourteen patients (11.8%) were referred to the acute care hospital because of severe medical complications. History of myocardial infarction, low admission Barthel ADL Index, urinary incontinence, indwelling catheterization, and dysphagia were risk factors of complications (p < 0.05). There were no specific risk factors of post-stroke depression. The risk factor of UTI was indwelling catheterization (RR 78.86, p < 0.001), CRPS type I was limited shoulder range of motion (RR 3.13, p = 0.035), pneumonia was aspiration (RR 145.33, p < 0.001), and cardiovascular complication was history of myocardial infarction (RR 7.70, p = 0.037). CONCLUSION The incidence of medical complication is 70.3%. Post-stroke depression, musculoskeletal pain, UTI and CRPS type I are the common complications. The risk factors of complications are low admission BAI, history of myocardial infarction, urinary incontinence, indwelling catheterization, and dysphagia. Awareness and screening of risk factors should be implemented to lower the incidence.