Rehabilitation Dose Contributes to Improvement in Transfer and Mobility Activities Among Patients With Ischemic Stroke Who Required Assistance Before Hospitalization: A Nationwide Database Observational Study.

Because the study used claims data, unmeasured confounding factors and selection bias may remain, even after weighting. The reported E-value was 1.42, which the authors describe as moderate, so residual confounding is still possible. The database did not record the content or type of rehabilitation interventions, so the contribution of physical therapy, occupational therapy, and speech-language therapy cannot be separated. Stroke severity adjustment was limited because stroke site and onset time were absent. Barthel Index and modified Rankin scale accuracy in claims data remains uncertain. Some 30-day outcomes were imputed, although complete-case sensitivity analyses were consistent. The study only included patients with modified Rankin scale scores of 4 or 5 before admission, so it does not address patients with lower preadmission dependence.

The investigators reported no financial or nonfinancial disclosures.

Do not read the dose associations as proof that adding minutes causes better recovery. The study is observational, and the daily dose includes physical therapy, occupational therapy, and speech-language therapy together, so the contribution of any single discipline cannot be separated.