Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study

Kinoshita, Tokio; Yoshikawa, Tatsuya; Nishimura, Yukihide; Kamijo, Yoshi‐ichiro; Arakawa, Hidetoshi; Nakamura, Takeshi; Hashizaki, Takamasa; Hoekstra, Sven P.; Tajima, Fumihiro

doi:10.1080/00207454.2020.1774578

Cited by 15 publications

(19 citation statements)

References 33 publications

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“…Evidence for these treatments is being collected, which leads to improved knowledge about early rehabilitation therapy ( 3 ). In observational studies from Japan ( 4 , 5 ), very early mobilization was associated with functional recovery of patients with stroke. Initiating rehabilitative care within 24 h of stroke is safe and useful if provided by skilled therapists under physiatrist supervision.…”

Section: Acute Phasementioning

confidence: 99%

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

et al. 2022

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In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.

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Section: Acute Phasementioning

confidence: 99%

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

et al. 2022

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“…In this hospital, physiatrists examined the patient before rehabilitation onset and evaluated the exact diagnosis, disease state, and physical condition. Subsequently, registered and skilled therapists initiated exercise therapy [11,12]. The initial rehabilitation program comprised extremity passive range-of-motion (ROM) training to prevent extremity contractures, as well as sitting on the edge of the bed to promote sputum evacuation, prevent ICU-AW occurrence, decrease circulating blood volume, and maintain autonomic blood pressure control function.…”

Section: Interventions For Patients With Covid-19mentioning

confidence: 99%

The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Kinoshita

Nishimura

Umemoto

et al. 2022

JCM

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This retrospective cohort study aimed to examine the rehabilitation effect of patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU) under mechanical ventilation and included ICU patients from a university hospital who received rehabilitation under ventilator control until 31 May 2021. Seven patients were included, and three of them died; thus, the results of the four survivors were examined. The rehabilitation program comprised the extremity range-of-motion training and sitting on the bed’s edge. The Sequential Organ Failure Assessment score (median (25–75th percentiles)) at admission was 7.5 (5.75–8.5), and the activities of daily living (ADLs) were bedridden, the lowest in the Functional Independence Measure (FIM) and Barthel Index (BI) surveys. Data on the mean time to extubation, ICU length of stay, and ADLs improvement (FIM and BI) during ICU admission were obtained. Inferential analyses were not performed considering the small sample size. The mean time to extubation was 4.9 ± 1.1 days, and the ICU length of stay was 11.8 ± 5.0 days. ΔFIM was 36.5 (28.0–40.5), and the ΔBI was 22.5 (3.75–40.0). Moreover, no serious adverse events occurred in the patients during rehabilitation. Early mobilization of patients with COVID-19 may be useful in ADLs improvement during ICU stay.

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“…The time was longer than in the previous study for acute-phase patients from our department, suggested as approximately 70 min. 10,11 The reason for the difference could be the fact that the present PROr was provided for chronic patients.…”

Section: Times Of Rehabilitationmentioning

confidence: 99%

“…7 In the Wakayama Medical University Hospital, an acute care and tertiary emergency medical facility, rehabilitation therapy is provided by a specialized team consisting of physiatrists and registered therapists operating rehabilitation. 10,11 Therapists and physiatrists attempt to provide rehabilitation with a high load and dose, as much as possible, depending on the condition of each patient. They recently reported that starting post-stroke rehabilitation within 24 h by experienced physical and occupational therapists, termed "physiatrist and registered therapist operating rehabilitation (PROr)," resulted in a better improvement in the functional independence measure (FIM) at discharge and at 6 months after stroke onset compared with starting therapy later than 24 h after stroke.…”

Section: Introductionmentioning

confidence: 99%

“…In the study, the inpatients undertook approximately 70 min of rehabilitation therapy per session for 2À3 weeks. 10,11 In 2015, the Japanese guideline for stroke treatments recommended more dose of rehabilitation than conventional therapy to improve ADL in patients in the early phase. 6 A dose of rehabilitation may be related to patients' motivation.…”

Section: Introductionmentioning

confidence: 99%

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Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study

Zaiki

Kamijo

Moriki

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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Mobilization within 24 hours of new-onset stroke enhances the rate of home discharge at 6-months follow-up: a prospective cohort study

Cited by 15 publications

References 33 publications

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

Transitional and Long-Term Care System in Japan and Current Challenges for Stroke Patient Rehabilitation

The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study

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