Comparative Effectiveness of Different Combinations of Treatment Interventions in Patients with Stroke at the Convalescence Stage Based on the Markov Decision Process

Abstract

Objective. The objective of this study was to compare the effectiveness of different combinations of interventions in patients with stroke at the convalescence stage based on the electronic health records (EHRs) by using the Markov decision process (MDP) theory and explore the feasibility of the Markov model in the real-world study (RWS). Methods. Screening was conducted for patients with stroke at the convalescence stage who were admitted to the Third Affiliated Hospital of Zhejiang Chinese Medical University from January 2012 to January 2017 based on the EHRs. The relevant clinical data were extracted, and the appropriate conversion was made (state-action-reward) according to the Markov model. The transformed data were analysed and solved by the MDP to obtain the best interventions for patients with various stroke recovery periods. Results. 926 patients with stroke at the convalescence stage were initially selected. And according to the inclusion exclusion criteria, 854 patients were screened. Through the MDP, we obtained the following results: (1)when the patients with stroke at the convalescence stage have a medical history, but no complications, and mild neurological impairment, ≥66-year- and 18–45-year-old patients are advised to choose acupuncture treatment. 46–65-year-old patients are advised to choose rehabilitation treatment. When patients with moderate to severe neurological impairment, patients are advised to choose rehabilitation, Chinese herbal decoction, and acupuncture combined therapy. (2) Without complications or medical history, patients who are ≥ 66 years old are recommended to choose rehabilitation treatment when the nerve function impairment is mild; rehabilitation and acupuncture treatment are recommended when moderate and severe injuries are caused. (3) The combination of rehabilitation, Chinese herbal decoction, and acupuncture treatment is recommended for patients with phlegm and blood stasis. Acupuncture treatment is recommended for patients with mild impairment of nerve function in qi deficiency and blood stasis type. Rehabilitation, Chinese herbal decoction, and acupuncture treatment are recommended for moderate-severe injuries. Conclusions. The MDP makes it possible to study the effectiveness of various treatment methods in stroke patients who are at the convalescence stage. Further exploratory studies using MDP theory in other areas in which complex interventions are common would be worthwhile.

A Promising Approach to Optimizing Sequential Treatment Decisions for Depression: Markov Decision Process

“…Using use TCM treatments for relaxing the bowels 5. Using herbal medicine Neurological functional impairment scores Compare effectiveness of different treatment combinations No Shen et al (2020) [ 26 ] Finite (every 7 d) Stroke 236 states (defined by age, disease history, complications, Western medicine diagnosis, and TCM syndrome differentiation) 1. Use rehabilitation therapy 2.…”

“…Researchers have applied MDP models to optimize initial treatment selection [25,26] and the timing of transplantation [27,28], to compare the effectiveness of different combinations of treatment [29], to optimize screening policy [30], and to prevent disease-related complications [31]. However, 16 studies concern the optimization of treatment decisions [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”

“…However, 16 studies concern the optimization of treatment decisions [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. Five studies use the MDP to optimize treatment decisions for cancer [30,35,39,42,43], five focus on optimizing the treatment of diabetes mellitus [31][32][33][34]41], and the remaining (N = 13) studies are concerned with liver diseases [27,28], high blood pressure/hypertension [37,40], hepatitis C [44], atherosclerotic cardiovascular disease [45], ischemic heart disease [29,36], atrial fibrillation [38], anemia [47], tuberculosis [46], aneurysms [25], and stroke [26].…”

Effect of opposing needling on motor cortex excitability in healthy participants and in patients with post-stroke hemiplegia: Study protocol for a single-blind, randomised controlled trial

“…One study recommended acupuncture for patients with various stroke recovery periods. [17] Acupuncture has been used to treat post-stroke hemiplegia for more than 2,000 years, and has shown significant therapeutic effects. [18,19] Opposing needling, one of the most common acupuncture treatments for post-stroke hemiplegia involves needle insertion in the healthy limb to improve motor function of the affected limb.…”

Effect of opposing needling on motor cortex excitability in healthy participants and in patients with post-stroke hemiplegia: study protocol for a single-blind, randomised controlled trial

“…Most patients in China with post-stroke hemiplegia are treated with a combination of Chinese and modern medicine. One study recommended acupuncture for patients with various stroke recovery periods [ 21 ]. Acupuncture has been used to treat post-stroke hemiplegia for more than 2000 years and has shown significant therapeutic effects [ 22 , 23 ].…”