Just one in five patients returns for rehab: Study

Mr Lim Peow Koon going through a rehabilitation exercise with therapy assistant Ian Richard Pereira at St Luke's Hospital in Bukit Batok yesterday. Mr Lim is among the minority of patients who faithfully return for rehab after their hospitalisation.
Mr Lim Peow Koon going through a rehabilitation exercise with therapy assistant Ian Richard Pereira at St Luke's Hospital in Bukit Batok yesterday. Mr Lim is among the minority of patients who faithfully return for rehab after their hospitalisation.ST PHOTO: DESMOND WEE

Reasons cited include cost and difficulty in getting to rehab centres

Just three months after their discharge, four out of five patients stop going for their prescribed rehabilitation programme.

This is of concern to doctors, as lack of rehabilitation often results in the patients' physical abilities deteriorating rapidly, turning them frail and often needing more frequent hospitalisation later on.

Dr Ng Yee Sin, head of rehabilitation medicine at Singapore General Hospital, said: "Compliance to rehabilitation is dismal."

Rehabilitation is important because without regular training of the muscles, their ability to function "deteriorates rapidly", he noted.

Equally concerned, Associate Professor Gerald Koh of the National University of Singapore Saw Swee Hock School of Public Health led a team to study why patients were dropping out.

They found that even before they were discharged, three out of five stroke patients had no intention of continuing the rehabilitation started while they were in hospital.

And by the end of the year, even the two in five who started off with keen interest would be whittled down to just one in 20 still on the regime.

The study results were published in the March edition of the Annals, a journal of the Singapore Academy of Medicine.

The study found that more than half of the 41 patients had difficulty going for rehabilitation because of their physical disability and their home environment.

The team noted that lifts in older blocks of flats served only a few floors, and many patients had difficulty climbing stairs without help.

Nineteen said there was no one to take them, even though several said they would like to go and found the sessions helpful.

Several found the cost prohibitive. Subsidies helped, but needing to go weekly or twice a week was expensive when transportation is included.

Said one patient: "I feel rehabilitation is a luxury."

Another patient, who is 75, said that at her age, lack of functional ability was part of growing old, and she saw no need to go for rehabilitation. Some others said they stopped because they saw no benefit.

But the doctors disagree with this. All studies point to improvements, or at least maintenance, of their functional abilities.

Dr Ng said patients who go for rehabilitation are less frail and depressed, enjoy better quality of life and have lower risk of falling.

Mr Lim Peow Koon, 53, is a case in point. More than a year after he suffered a stroke, the former welder is still turning up twice a week at St Luke's Hospital in Bukit Batok for his two-hour sessions.

The spur is the visible improvements he has seen. A year ago, his wife had to help him eat and dress himself, among other things.

Today, although still visibly limping, he is not only able to care for himself but also able to take the hour-long bus trip to St Luke's on his own. When he was first referred there by the National University Hospital in May last year, he had to go in a taxi, and later, on the bus with his wife's help.

But Mr Lim does find the $10.20 he has to pay per session a bit high, although it is already subsidised. The full rate is $51.

Now, he is looking forward to getting a job with the help of the Society for the Physically Disabled, which should make it easier to pay for the rehabilitation.

Prof Koh's team recommended subsidies for home rehabilitation, especially for the severely disabled, so they will not miss out on the window for improvement.

salma@sph.com.sg