Relationship between the intensity of stroke rehabilitation and outcome: A survey conducted by the Kaifukuki Rehabilitation Ward Association in Japan (second report)

Nagai, Shota; Sonoda, Shigeru; Miyai, Ichiro; Kakehi, Atsuo; Goto, Sachiko; Takayama, Yuko; Ota, Toshio; Ito, Isao; Yamamoto, Shinichi; Takizawa, Yasuki; Kaku, Katsuyuki; Inoue, Yasuhiro; Ishikawa, Makoto

doi:10.11336/jjcrs.2.77

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…Next, though there should be differences in the number of rehabilitation units, the relationship between rehabilitation time and patient severity has not been clear. Although a positive relationship between rehabilitation time and patient outcomes has been reported in the post-acute stage [ 31 , 32 ], there is no consensus about the acute stage [ 33 ]. Some studies report that, by increasing intensity of rehabilitation in the acute stage, post-stroke severity in patients would be improved [ 3 , 4 ]; however, Lauro et al reported no significant effect of the same [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients

Morii

Abiko

Osanai

et al. 2023

Cost Eff Resour Alloc

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Background Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer’s perspective, and public healthcare and long-term care payerʼs perspective in Japan. Methods Cost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis. Results The ICER was $6339/QALY from public health payer’s perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payerʼs perspective. The result of sensitivity analysis confirmed the results. Conclusion The results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients

Morii

Abiko

Osanai

et al. 2023

Cost Eff Resour Alloc

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“…They reported that the motor FIM score gain, the motor FIM effi ciency, and the rate of discharge to home were signifi cantly higher in the group with seven to nine units of rehabilitation than in the group with fi ve to six units of rehabilitation. Nagai et al [22] compared the amount of exercise and the rehabilitation outcomes among many hospitals. Classifying 11 hospitals into three groups according to the number of rehabilitating units offered: less than four units, four or fi ve units, and six or more units, they reported that the motor FIM effi ciency was signifi cantly higher in the hospitals offering six or more units than in those offering less than four units.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, there are diffi culties in clarifying the relationship between the amount of exercise and rehabilitation outcomes. A previous study reported that the rehabilitation systemrelated factors that affected the rehabilitation outcomes in a hospital included the number of staff members, the layout of the hospital ward, the equipment and instruments of the hospital, and cooperation with other medical and welfare institutions [22]. Considering the fact that not only the amount but also the quality of rehabilitation affects the rehabilitation outcomes, it is understandable that there was a signifi cant difference in FIM score gain between the two groups classifi ed according to the amount of exercise in the report of Jeong et al [19] and that the ranking of the three hospitals based on adjusted FIM effi ciency differed from that based on the amount of exercise in our study.…”

Section: Discussionmentioning

confidence: 99%

Relationship between hospital ranking based on Functional Independence Measure (FIM) efficiency and factors related to rehabilitation system for stroke patients -A study of three hospitals participating in Kumamoto Stroke Liaison Critical Pathway-

Tokunaga

Sannomiya

Watanabe

et al. 2012

Jpn J Compr Rehabil Sci

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measure (FIM) effi ciency by conducting a questionnaire survey in the kaifukuki rehabilitation hospitals (KRHs) participating in the Kumamoto Stroke Liaison Critical Pathway. Methods: A total of 765 stroke patients were studied. FIM score gain and length of stay (LOS) at three hospitals in Kumamoto were classifi ed into two groups according to patients' age and into three groups according to their FIM score at the time of admission. Then, FIM score gain and LOS were adjusted by the standard severity distribution value of the 765 patients to obtain the adjusted FIM effi ciency. The hospitals were ranked by the adjusted FIM effi ciency. In addition, we conducted a questionnaire survey on six factors related to the rehabilitation system and determined the factors that ranked the hospitals in the same order as that from ranking based on adjusted FIM effi ciency. Results: The adjusted FIM effi ciencies were 0.251 in Hospital A, 0.205 in Hospital B, and 0.225 in Hospital C. Among the six factors surveyed, the factors that gave the same hospital ranking as that based on adjusted FIM effi ciency were the number of rehabilitation and nursing staff members, and the number of patients hospitalized for stroke. Conclusion: Among the three hospitals in Kumamoto, the FIM effi ciency was high in the hospital with a large number of rehabilitation and nursing staff members and a large number of patients hospitalized for stroke.

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Level of Effort and 3 Hour Rule Compliance

Beaulieu

Peng

Hade

et al. 2019

Archives of Physical Medicine and Rehabilitation

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Objective: To determine if patients' level of effort (LOE) in therapy sessions during traumatic brain injury (TBI) rehabilitation modifies the effect of compliance with the 3-Hour Rule of the Centers for Medicare & Medicaid Services. Design: Propensity score methodology applied to the TBI-Practice-Based Evidence (TBI-PBE) database, consisting of multi-site, prospective, longitudinal observational data. Setting: Acute inpatient rehabilitation facilities (IRF). Participants: Patients (n=1820) who received their first IRF admission for TBI in the US and were enrolled for 3 and 9 month follow-up. Main Outcome Measures: Participation Assessment with Recombined Tools-Objective-17, FIM TM Motor and Cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9. Results: When the full cohort was examined, no strong main effect of compliance with the 3-Hour Rule was identified and LOE did not modify the effect of compliance with the 3-Hour Rule. In contrast, LOE had a strong positive main effect on all outcomes, except depression. When the sample was stratified by level of disability, LOE modified the effect of compliance, particularly on the outcomes of participants with less severe disability. For these patients, providing 3 hours of therapy for 50%+ of therapy days in the context of low effort resulted in

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Relationship between the intensity of stroke rehabilitation and outcome: A survey conducted by the Kaifukuki Rehabilitation Ward Association in Japan (second report)

Cited by 8 publications

References 5 publications

Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients

Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients

Relationship between hospital ranking based on Functional Independence Measure (FIM) efficiency and factors related to rehabilitation system for stroke patients -A study of three hospitals participating in Kumamoto Stroke Liaison Critical Pathway-

Level of Effort and 3 Hour Rule Compliance

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