Current status of acute stroke rehabilitation at primary stroke centers in Japan: a nationwide cross-sectional web-based questionnaire survey

Kakuda, Wataru; Oki, Koichi; Nakajima, Makoto; Koyama, Tetsuo; Oyama, Naoki; Koga, Masatoshi; Hayase, Makoto; Ohta, Tsuyoshi; Omori, Tomohiro; Matsumoto, Koichí; Iguchi, Yasuyuki; Fujimoto, Shigeru; Ogasawara, Kuniaki

doi:10.3995/jstroke.11058

Cited by 4 publications

(13 citation statements)

References 14 publications

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“…Among these, the present report focuses on “timings for the initiation of acute stroke rehabilitation” and “management of rehabilitation in the event of complications.” The other results in this survey have already been published [18], and further analysis will be published elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Oki¹,

Nakajima²,

Koyama³

et al. 2023

Cerebrovasc Dis

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Introduction: Many guidelines now recommend early rehabilitation for acute stroke patients. However, evidence remains lacking regarding the specific timings for initiation of various rehabilitation steps and management when complications are encountered in acute stroke rehabilitation. This survey aimed to investigate actual clinical situations in acute stroke rehabilitation in Japan and to improve the medical systems for rehabilitation and plan further studies. Methods: This nationwide, cross-sectional, web-based questionnaire survey was administered between February 7, 2022, and April 21, 2022, targeting all primary stroke centers (PSCs) in Japan. Among several components of the survey, this paper focused on the timing of the initiation of three rehabilitation steps (passive bed exercise; head elevation; and out-of-bed mobilization), along with the management of rehabilitation (continued or suspended) in the event of complications during acute stroke rehabilitation. We also investigated the influence of facility features on these contents. Results: Responses were obtained from 639 of the 959 PSCs surveyed (response rate: 66.6%). In cases of ischemic stroke and intracerebral hemorrhage, most PSCs initiated passive bed exercise on day 1, head elevation on day 1, and out-of-bed mobilization on day 2 (with day of admission defined as day 1). In cases with subarachnoid hemorrhage, rehabilitation steps were delayed compared to other stroke subtypes or showed wide variation depending on the facility. Passive bed exercise was accelerated by the presence of protocols for rehabilitation and weekend rehabilitation. Out-of-bed mobilization was accelerated by the presence of a stroke care unit. Facilities with board-certified rehabilitation doctors were cautious regarding the initiation of head elevation. Most PSCs suspended rehabilitation training in the event of symptomatic systemic/neurological complications. Conclusion: Our survey revealed the actual situation of acute stroke rehabilitation in Japan and indicated that some facility features appear to influence early increases in physical activity levels and early mobilization. Our survey provides fundamental data to improve the medical systems for acute stroke rehabilitation in the future.

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Section: Methodsmentioning

confidence: 99%

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Oki¹,

Nakajima²,

Koyama³

et al. 2023

Cerebrovasc Dis

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“…The results of a questionnaire survey of 959 primary stroke centers in Japan showed that in-bed training and head elevation tended to start later in patients with subarachnoid hemorrhage than in those with cerebral infarction and intracerebral hemorrhage (nonoperative patients). 44 ) However, no evidence has been presented regarding whether training can prevent cerebral vasospasm or whether continuing training in the presence of cerebral vasospasm improves the patient outcome.…”

Section: Clinical Questionsmentioning

confidence: 99%

“… 55 ) A questionnaire survey on the status of rehabilitation at primary stroke centers in Japan showed that the greatest number of facilities had an initial training time of 40 min/day, followed by 60–80 min/day, and 20 min/day, in that order. 44 )…”

Section: Clinical Questionsmentioning

confidence: 99%

“…A questionnaire survey on the status of rehabilitation at primary stroke centers in Japan showed that training was implemented 7 days a week at 30% of the facilities, 6 days a week at 41%, and 5 days a week at 22%. 44 ) A study using a multicenter database of 3072 stroke patients showed a higher proportion of good outcomes (mRS scores of 0–2) at discharge in a group that underwent training 7 days a week as compared with a group that underwent training 5 or 6 days a week. 57 ) A single-center analysis of chart data for 661 patients with ischemic stroke found that BI results at discharge were better and DVT during hospitalization was reduced when rehabilitation training was implemented on non-workdays as well as weekdays.…”

Section: Clinical Questionsmentioning

confidence: 99%

“… 73 , 76 , 79 , 92 , 113 ) A questionnaire survey conducted in Japan found that 50% of primary stroke centers performed both VF and VE, whereas 24% performed VF alone, and 17% performed VE alone. 44 )…”

Section: Clinical Questionsmentioning

confidence: 99%

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Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version

Kakuda,

Nakajima,

Oki

et al. 2024

PRM

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Objectives: In Japan, acute stroke rehabilitation has been expanding more steadily than previously with the nationwide establishment of primary stroke centers. However, Japan previously had no established guidelines for the rehabilitation. Consequently, rehabilitation programs and the provision systems for acute stroke varied among the facilities. To equalize and standardize acute stroke rehabilitation in Japan, it is necessary to develop clinical recommendations for rehabilitation. Therefore, the rehabilitation project team of the Japan Stroke Society aimed to develop the first recommendations for acute stroke rehabilitation in Japan. Methods: The recommendations are based on the results of a survey on the current status of acute stroke rehabilitation at primary stroke centers in Japan, which was completed in 2022, and on a literature review conducted by the rehabilitation project team. Results: The recommendations consist of 19 clinical questions regarding the following topics of acute stroke rehabilitation: (1) head elevation and mobilization training, (2) acute complications, (3) training time and frequency for acute stroke rehabilitation, (4) dysphagia in the acute phase, and (5) acute rehabilitation during pandemics of novel and re-emerging infections, particularly novel coronavirus disease 2019 (COVID-19). The team members agreed on all answers for these 19 clinical questions. Conclusions: These recommendations suggest broad principles of rehabilitative intervention in the acute phase of stroke. In the near future, it is expected that the dissemination of these recommendations will result in an increase in the quality of acute stroke rehabilitation in Japan.

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A nationwide survey for the provision of acute stroke rehabilitation in Japan: initial dose and weekend/holiday rehabilitation

Nakajima,

Oki,

Omori

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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Current status of acute stroke rehabilitation at primary stroke centers in Japan: a nationwide cross-sectional web-based questionnaire survey

Abstract: Current status of acute stroke rehabilitation at primary stroke centers in Japan: a nationwide cross-sectional web-based questionnaire survey

Cited by 4 publications

References 14 publications

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Timing of Initiation of Acute Stroke Rehabilitation and Management Corresponding to Complications at Primary Stroke Centers in Japan: A Nationwide Cross-Sectional Web-Based Questionnaire Survey

Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version

A nationwide survey for the provision of acute stroke rehabilitation in Japan: initial dose and weekend/holiday rehabilitation

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