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Association between volume of patients undergoing stroke rehabilitation at acute care hospitals and improvement in activities of daily living

  • Takuaki Tani
    Correspondence
    Corresponding author: Prof. Kiyohide Fushimi, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
    Affiliations
    Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan

    Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
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  • Shinobu Imai
    Affiliations
    Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan

    Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan
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  • Norihiko Inoue
    Affiliations
    Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan

    Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
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  • Natsuko Kanazawa
    Affiliations
    Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
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  • Kiyohide Fushimi
    Correspondence
    Corresponding author: Prof. Kiyohide Fushimi, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
    Affiliations
    Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan

    Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
    Search for articles by this author

      Highlight

      • The volume of rehabilitation is measured by the number of patients treated at the institution as a clinical indicator of the quality of acute stroke rehabilitation.
      • The study aimed to determine the relationship between the annual volume of patients provided with rehabilitation per hospital and the outcomes of patients admitted for acute stroke.
      • The annual volume of stroke patients undergoing multi-disciplinary rehabilitation was associated with the improvement of ADL.

      Abstract

      Background

      This study aimed to determine the relationship between the annual volume of patients undergoing rehabilitation per hospital and the outcomes of patients admitted for acute stroke.

      Methods

      This observational study used nationwide administrative data. Data on stroke patients aged ≥ 20 years who underwent rehabilitation were extracted from 1,182 acute care hospitals in Japan. The exclusion criteria were extended hospital stay exceeding 180 days and death during hospitalization. Hospital volumes were divided into four quartiles of total patients per hospital. The primary outcome was an improvement in activities of daily living from admission to discharge measured using the Barthel index. Poisson regression analysis of activities of daily living improvement was performed using inverse probability of treatment weighting.

      Results

      High rehabilitation volume was significantly correlated with improvements in activities of daily living using the “very low group” as a reference (risk ratio [95% confidence interval]): 1.06 [1.05–1.08], P<0.001). Low volume was also significantly associated with activities of daily living improvement (risk ratio [95% confidence interval]: 1.04 [1.03–1.06], P<0.001).

      Conclusions

      The annual volume of stroke patients undergoing multidisciplinary rehabilitation at a specific hospital may be a factor in the degree of patient improvement in activities of daily living

      Keywords

      List of Abbreviations:

      BMI (body mass index), CCI (Charlson comorbidity index), GAM (generalized additive model), GLM (generalized linear model), IC (inverse probability weightin), IPTW (inverse probability weighting), JCS (Japan Coma Scale), LOS (length of hospital stays), MICE (multivariate imputation by chained equations), MT (Mechanical thrombectomy), mRS (modify rank scale), RR (Risk ratio), SCU (stroke care unit), SD (standard deviation), SMD (standard mean difference), t-PA (tissue plasminogen activator)
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      References

        • McGlinchey MP
        • James J
        • McKevitt C
        • et al.
        The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review.
        Syst Rev. 2018 Nov 17; 7: 197
        • Murray CJL
        • Barber RM
        • Foreman KJ
        • et al.
        Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition.
        The Lancet. 2015; 386: 2145-2191
        • Winstein CJ
        • Stein J
        • Arena R
        • et al.
        Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2016 Jun; 47: e98-e169
        • Schneider EJ
        • Lannin NA
        • Ada L
        • et al.
        Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.
        J Physiother. 2016 Oct; 62: 182-187
        • Strasser DC
        • Falconer JA
        • Herrin JS
        • et al.
        Team functioning and patient outcomes in stroke rehabilitation.
        Arch Phys Med Rehabil. 2005 Mar; 86: 403-409
        • Poorthuis MHF
        • Brand EC
        • Halliday A
        • et al.
        High Operator, and Hospital Volume Are Associated With a Decreased Risk of Death and Stroke After Carotid Revascularization: A Systematic Review and Meta-analysis.
        Ann Surg. 2019 Apr; 269: 631-641
        • Lee KJ
        • Kim JY
        • Kang J
        • et al.
        Hospital Volume and Mortality in Acute Ischemic Stroke Patients: Effect of Adjustment for Stroke Severity.
        J Stroke Cerebrovasc Dis. 2020 May; 29104753
        • Weiner BJ
        • Alexander JA
        • Shortell SM
        • et al.
        Quality improvement implementation and hospital performance on quality indicators.
        Health Serv Res. 2006 Apr; 41: 307-334
        • Hu GC
        • Hsu CY
        • Yu HK
        • et al.
        Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.
        Arch Phys Med Rehabil. 2014 Feb; 95: 269-275
        • Graham JE
        • Deutsch A
        • O'Connell AA
        • et al.
        Inpatient rehabilitation volume and functional outcomes in stroke, lower extremity fracture, and lower extremity joint replacement.
        Med Care. 2013 May; 51: 404-412
        • Powers WJ
        • Rabinstein AA
        • Ackerson T
        • et al.
        Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
        Stroke. 2019 Dec; 50: e344-e418
        • Hayashida K
        • Murakami G
        • Matsuda S
        • et al.
        History and Profile of Diagnosis Procedure Combination (DPC): Development of a Real Data Collection System for Acute Inpatient Care in Japan.
        J Epidemiol. 2021 Jan 5; 31: 1-11
        • Okamura S
        • Kobayashi R
        • Sakamaki T.
        Case-mix payment in Japanese medical care.
        Health Policy. 2005 Nov; 74: 282-286
        • KF Shinya Matsuda
        • Fushimi Kiyohide
        Development of Casemix Based Evaluation System in Japan.
        Asian Pacific Journal of Disease Management. 2010; 4: 55-66
        • Shigemori M
        • Abe T
        • Aruga T
        • et al.
        Guidelines for the Management of Severe Head Injury, 2nd Edition guidelines from the Guidelines Committee on the Management of Severe Head Injury, the Japan Society of Neurotraumatology.
        Neurol Med Chir (Tokyo). 2012; 52: 1-30
        • Hsieh YW
        • Wang CH
        • Wu SC
        • et al.
        Establishing the minimal clinically important difference of the Barthel Index in stroke patients.
        Neurorehabil Neural Repair. 2007 May-Jun; 21: 233-238
        • Deeks A
        • Lombard C
        • Michelmore J
        • et al.
        The effects of gender and age on health related behaviors. 9. BMC Public Health, 2009 Jun 30: 213
        • Quan H
        • Sundararajan V
        • Halfon P
        • et al.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005 Nov; 43: 1130-1139
        • Austin PC
        • Stuart EA.
        Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.
        Stat Med. 2015 Dec 10; 34: 3661-3679
        • Austin PC.
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009 Nov 10; 28: 3083-3107
        • McCaffrey DF
        • Griffin BA
        • Almirall D
        • et al.
        A tutorial on propensity score estimation for multiple treatments using generalized boosted models.
        Stat Med. 2013 Aug 30; 32: 3388-3414
        • Zou G.
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004 Apr 1; 159: 702-706
        • Sv Buuren
        Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations inR.
        J Stat Softw. 2011; 45
        • Wood SN.
        Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models.
        J R Stat Soc B. 2011; 73: 3-36
        • Banzi R
        • Moja L
        • Liberati A
        • et al.
        Measuring the impact of evidence: the Cochrane systematic review of organized stroke care.
        Intern Emerg Med. 2009 Dec; 4: 507-510
      1. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial.
        The Lancet. 2015; 386: 46-55
        • Bernhardt J
        • Dewey H
        • Thrift A
        • et al.
        A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility.
        Stroke. 2008 Feb; 39: 390-396
        • Roth EJ
        • Lovell L
        • Harvey RL
        • et al.
        Incidence of and risk factors for medical complications during stroke rehabilitation.
        Stroke. 2001 Feb; 32: 523-529
        • Birkmeyer JD
        • Siewers AE
        • Finlayson EV
        • et al.
        Hospital volume and surgical mortality in the United States.
        N Engl J Med. 2002 Apr 11; 346: 1128-1137
        • Hacke W
        • Kaste M
        • Bluhmki E
        • et al.
        Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.
        N Engl J Med. 2008 Sep 25; 359: 1317-1329
        • Ogata T
        • Christensen S
        • Nagakane Y
        • et al.
        The effects of alteplase 3 to 6 hours after stroke in the EPITHET-DEFUSE combined dataset: post hoc case-control study.
        Stroke. 2013 Jan; 44: 87-93
        • Harvey PR
        • Trudgill NJ.
        The association between physician staff numbers and mortality in English hospitals.
        EClinicalMedicine. 2021 Feb; 32100709