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)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
- 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
- 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
- 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
- Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review.J Physiother. 2016 Oct; 62: 182-187
- Team functioning and patient outcomes in stroke rehabilitation.Arch Phys Med Rehabil. 2005 Mar; 86: 403-409
- 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
- Hospital Volume and Mortality in Acute Ischemic Stroke Patients: Effect of Adjustment for Stroke Severity.J Stroke Cerebrovasc Dis. 2020 May; 29104753
- Quality improvement implementation and hospital performance on quality indicators.Health Serv Res. 2006 Apr; 41: 307-334
- 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
- Inpatient rehabilitation volume and functional outcomes in stroke, lower extremity fracture, and lower extremity joint replacement.Med Care. 2013 May; 51: 404-412
- 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
- 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
- Case-mix payment in Japanese medical care.Health Policy. 2005 Nov; 74: 282-286
- Development of Casemix Based Evaluation System in Japan.Asian Pacific Journal of Disease Management. 2010; 4: 55-66
- 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
- Establishing the minimal clinically important difference of the Barthel Index in stroke patients.Neurorehabil Neural Repair. 2007 May-Jun; 21: 233-238
- The effects of gender and age on health related behaviors. 9. BMC Public Health, 2009 Jun 30: 213
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med Care. 2005 Nov; 43: 1130-1139
- 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
- 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
- A tutorial on propensity score estimation for multiple treatments using generalized boosted models.Stat Med. 2013 Aug 30; 32: 3388-3414
- A modified Poisson regression approach to prospective studies with binary data.Am J Epidemiol. 2004 Apr 1; 159: 702-706
- Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations inR.J Stat Softw. 2011; 45
- Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models.J R Stat Soc B. 2011; 73: 3-36
- Measuring the impact of evidence: the Cochrane systematic review of organized stroke care.Intern Emerg Med. 2009 Dec; 4: 507-510
- Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial.The Lancet. 2015; 386: 46-55
- A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility.Stroke. 2008 Feb; 39: 390-396
- Incidence of and risk factors for medical complications during stroke rehabilitation.Stroke. 2001 Feb; 32: 523-529
- Hospital volume and surgical mortality in the United States.N Engl J Med. 2002 Apr 11; 346: 1128-1137
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N Engl J Med. 2008 Sep 25; 359: 1317-1329
- 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
- The association between physician staff numbers and mortality in English hospitals.EClinicalMedicine. 2021 Feb; 32100709
Article info
Publication history
Published online: November 27, 2022
Accepted:
October 31,
2022
Received in revised form:
October 23,
2022
Received:
June 3,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106872
Copyright
© 2022 Elsevier Inc. All rights reserved.
