Impact of rehabilitation start time on functional outcomes after stroke

Abstract

This study examined the effect on functional outcomes of the time after stroke of starting rehabilitation. A large national database was searched for eligible stroke patients, resulting in a total of 140,655 patients from 1,161 hospitals. Starting rehabilitation on the day of admission or second day of hospitalization after stroke was found to be associated with better functional outcomes at dis charge than starting rehabilitation on the third day or later. For patients with haemorrhagic stroke, those who started rehabilitation on the second day of hospitalization had better functional outcome at discharge than those who started on the day of admission. Thus, starting rehabilitation on the day of admission or the second day of hospitalization after stroke may be the best timing for improved functional outcomes. However, among patients with haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may result in better out comes than starting on the day of admission.Objective: To investigate the optimum rehabilitation start timing for improved functional outcomes after stroke in Japan. Design: A retrospective database study. Subjects: A total of 140,655 patients with stroke from 1,161 acute hospitals in Japan. Only data for those patients who were discharged alive was includ ed in the analysis. Methods: Activities of daily living were assess ed. Comparisons were made using the rehabilita tion start day after hospital admission. Reference day 2 was compared with days 1, 3, 4, 5, and 6 or later. Modified Rankin Scale at time of discharge was used as the primary outcome. In addition, cases of is chaemic stroke and haemorrhagic stroke were analysed as separate subgroups. Results: Univariate and multivariate logistic regres sion analyses showed that starting rehabilitation on day 2 resulted in a better outcome than starting on day 3 or later. There was no significant difference in outcome between starting rehabilitation on days 1 or 2 in all cases and subgroup of patient with infarc tion stroke. For a subgroup of patients with haem orrhagic stroke, starting rehabilitation on day 2 resulted in a better outcome than starting on day 1. Conclusion:Starting post-stroke rehabilitation on the day of admission or second day of hospitalization may be the optimum timing for functional outcomes. However, for haemorrhagic stroke, starting rehabil itation on the second day of hospitalization may be more effective than on the day of admission.

Association between Care-need Level after Discharge and Long-term Outcomes in 7491 Patients Requiring Rehabilitation for Stroke

“…The current study mainly included patients with cerebral infarction, and the remaining patients had hemorrhage. This distribution was similar to that in previous retrospective studies on rehabilitation for stroke (18) , (19) , (33) , (34) . Nevertheless, the mean age of the patients was higher in the current study compared with those of the previous studies, presumably because of the nature of the current database; that is, the database included almost all residents aged 65 years or older but did not include residents aged 40-64 years who joined the employee’s insurance (insurance other than the National Health Insurance).…”

Factors Associated With Stroke Mortality in an Urban-Rural Environment: The Case of the MONKOLE Hospital Centre

“…Anticoagulation was the only treatment for the aetiology of ischaemic stroke in the absence of thrombolysis, in accordance with the work of Mohammad Mehdi [25]. Early physiotherapy was used less frequently, in disagreement with the results of Sonfo and Satoshi Otokita [15,26]. Half the patients had sequelae on discharge, as Ramon Luengo-Fernandez had observed [27].…”

Validity of identification algorithms combining diagnostic codes with other measures for acute ischemic stroke in MID‐NET®

“…When stroke rehabilitation was added as "AND" condition to the identification algorithm, the sensitivity decreased to approximately 30%, and the PPV was >0.8. Early rehabilitation has been demonstrated to improve physical functioning impaired by ischemic stroke, 17,27 and a previous validation study reported that the probability of being a true AIS is particularly high in cases transferred from a neurology department to a rehabilitation department. 28 Therefore, we consider that the information on rehabilitation effectively identifies patients with AIS.…”

“…Shima et al 15 also reported that the positive predictive values (PPVs) for outcome identification algorithms were increased when event-specific treatment data for ischemic stroke were added to the algorithm based on diagnostic codes alone. However, there is few evidence regarding the validity of identification algorithms consisting of ICD-10 diagnostic codes in combination with other measures for hospitalized patients with AIS 16,17 in administrative databases, such as diagnostic imaging, drug administration, mechanical thrombectomy, or rehabilitation. In the present study, we assessed the validity of identification algorithms consisting of several combinations of ICD-10 diagnostic codes and other measures for inpatients with AIS.…”