การฟื้นฟูสภาพผู้สูงอายุโรคหลอดเลือดสมองไทย

Objective: To study the efficacy of Thai traditional massage (TTM) in decreasing muscle spasticity, physical performance, anxiety and depression, and quality of life (QoL) in Thai Stroke patients compared to physical therapy (PT) program.
Design: Randomized controlled trial with blinded assessor.
Subjects: 50-outpatient stroke with onset more than 3 months, aged more than or equal to 50 years, able to communicate and having spasticity at elbow or knee muscles at least grade 1+ of Modified Ashworth Scale (MAS)
Methods: The study group (24 subjects) received TTM and control group (26 subjects) received PT program, twice a week for 6-week duration at Siriraj Hospital. Spasticity level, physical performance, anxiety and depression, and quality of life were measured at baseline, 6 and 10 weeks.
Results: At 6-week, the number of patients whose spasticity were decreased at least 1 grade were 70.8% vs. 61.9% in study and control groups respectively which was no statistical significance between groups (p=0.286). Comparing within group at the beginning, 6 and 10 weeks, both TTM and PT program can increase physical performance with p=0.004 and p=0.002, but those value was not different among groups (p= 0.123). Concerning psychological status, the anxiety and depression scores decreased at 6-week and increased at 10-week durations in both groups. The anxiety score in TTM was significant different (p=0.012). Within group comparison, there was not different of QoL score in TTM group whereas physical and emotion dimensions of QoL score in PT group showed statistically significant. However, no difference of mean difference of QoL score was found when compared between groups at 6- or 10-week durations. There were trend of increased adverse 112 events (AE) in musculoskeletal system in TTM more than PT group, as well as the percentage of patients who felt that their spasticity decreased. However, subjects who satisfied with TTM were less than in PT group. Conclusion: This preliminary report showed that no evidence to prove that TTM was different from PT program in decreasing muscle spasticity due to small sample size. However, both interventions can decrease spasticity, anxiety and depression scores, and increase functional ability and QoL at week 6. The long term outcomes after stop treatment were increasing anxiety and depression scores, while decreasing QoL score at week 10. The number of musculoskeletal system AE was much more in TTM group than PT group. The number of patients who satisfied with treatment in TTM was less even though number of patients who felt decreased spasticity was more in TTM group than in PT group.