Abstract
Aim: To examine the association of the amount of rehabilitation with functional gains
of elderly stroke patients at a convalescent rehabilitation ward using propensity
score analysis methods and the Japan Rehabilitation Database.
Methods: This study was a retrospective cohort study. From the database, 6875 patients who
were admitted to the convalescent rehabilitation wards with stroke were identified.
After excluding 4586 patients, 2325 were eligible for the study. Intensive rehabilitation
therapy (IRT) was defined as rehabilitation therapy of more than 15 hours per week
by a physical therapist, an occupational therapist, and/or a speech therapist. Functional
Independence Measure (FIM) gain, discharge rate to home, and FIM efficiency were examined
using student's t test and the χ2 test after inverse probability weighting (IPW).
Results: IRT was provided to 862 patients (37.1%). The unadjusted data showed that patients
in the IRT group had a longer hospital stay, more physical therapy, occupational therapy,
and speech and language therapy. After adjustment for IPW, the baseline characteristics
were found to be closely matched between the 2 groups. The IRT group showed significantly
higher motor FIM gain, cognitive FIM gain, FIM gain, and discharge rate to home.
Conclusions: The present study demonstrated that a longer rehabilitation time per week was associated
with increased functional gain in elderly stroke patients at convalescent rehabilitation
wards.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cost-effectiveness of the medicare three-hour regulation.Arch Phys Med Rehabil. 1986; 67: 581-585
- Results of new policies for inpatient rehabilitation coverage in Japan.Neurorehabil Neural Repair. 2011; 25: 540-547https://doi.org/10.1177/1545968311402696
- The care of elderly patients with hip fracture.N Engl J Med. 1988; 319: 1392-1397https://doi.org/10.1056/NEJM198811243192106
- The relationship between duration of physical therapy services in the acute care setting and change in functional status in patients with lower-extremity orthopedic problems.Phys Ther. 1998; 78: 19-24
- Regaining functional independence in the acute care setting following hip fracture.Phys Ther. 1996; 76: 818-826
- Association between 7 days per week rehabilitation and functional recovery of patients with acute stroke: a Retrospective Cohort Study based on the Japan Rehabilitation Database.Arch Phys Med Rehabil. 2017; 98: 701-706https://doi.org/10.1016/j.apmr.2016.11.004
- Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better.Arch Phys Med Rehabil. 2005; 86: S101-S114https://doi.org/10.1016/j.apmr.2005.09.016
- Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit.Disabil Rehabil. 2010; 32: 1251-1259https://doi.org/10.3109/09638280903464448
- Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of japan rehabilitation database.J Stroke Cerebrovasc Dis. 2015; 24: 1019-1024https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.026
- Ability of Functional Independence Measure to accurately predict functional outcome of stroke-specific population: systematic review.J Rehabil Res Dev. 2010; 47: 17https://doi.org/10.1682/JRRD.2009.08.0140
- Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.J Physiother. 2016; 62: 182-187https://doi.org/10.1016/j.jphys.2016.08.006
- Daily treatment time and functional gains of stroke patients during inpatient rehabilitation.PMR. 2013; 5: 122-128https://doi.org/10.1016/j.pmrj.2012.08.013
- The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities.Arch Phys Med Rehabil. 2005; 86: 373-379https://doi.org/10.1016/j.apmr.2004.10.018
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
- Intensity of aphasia therapy, impact on recovery.Stroke. 2003; 34: 987-992https://doi.org/10.1161/01.STR.0000062343.64383.D0
- Effects of augmented exercise therapy time after stroke: a meta-analysis.Stroke. 2004; 35: 2529-2536https://doi.org/10.1161/01.STR.0000143153.76460.7d
- National clinical guideline for stroke, 5th edn. London:.Royal College of Physicians, 2016
- Clinical guidelines for stroke management.National Stroke Foundation, 2017 (last accessed June 19, 2019). Published 2017
- Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American heart association.Stroke. 2010; 41: 2402-2448https://doi.org/10.1161/STR.0b013e3181e7512b
- An inpatient rehabilitation service for deconditioned older adults.Top Geriatr Rehabil. 2007; 23: 126-136https://doi.org/10.1097/01.TGR.0000270181.06027.7d
- Association between therapy intensity and discharge outcomes in aged medicare skilled nursing facilities admissions.Arch Phys Med Rehabil. 2018; 99: 107-115https://doi.org/10.1016/j.apmr.2017.07.012
- Rehabilitation in skilled nursing facilities: effect of nursing staff level and therapy intensity on outcomes.Am J Phys Med Rehabil. 2004; 83: 704-712https://doi.org/10.1097/01.PHM.0000137312.06545.D0
- Skilled nursing facility rehabilitation and discharge to home after stroke.Arch Phys Med Rehabil. 2005; 86: 442-448https://doi.org/10.1016/j.apmr.2004.06.067
- Randomized trials or observational tribulations?.N Engl J Med. 2000; 342: 1907-1909https://doi.org/10.1056/nejm200006223422511
- Randomized, controlled trials, observational studies, and the hierarchy of research designs.N Engl J Med. 2000; 342: 1887-1892https://doi.org/10.1056/NEJM200006223422507
- A comparison of observational studies and randomized, controlled trials.N Engl J Med. 2000; 342: 1878-1886https://doi.org/10.1056/NEJM200006223422506
Article Info
Publication History
Published online: June 22, 2019
Accepted:
June 2,
2019
Received in revised form:
May 15,
2019
Received:
April 22,
2019
Footnotes
Financial Disclosure: None.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.007
Copyright
© 2019 Elsevier Inc. All rights reserved.
