Rehabilitation of Patients With Acute Ischemic Stroke Who Required Assistance Before Hospitalization Contributes to Improvement in Activities of Daily Living: A Nationwide Database Cohort Study.
Takuaki Tani, Shinobu Imai, Kiyohide Fushimi
PMID 36545520WHAT IT FOUND
Starting rehabilitation early and increasing daily duration improved daily living activities in stroke patients who needed help before admission.
This benefit held for those with moderate disability, but early rehabilitation did not improve outcomes for the most severely disabled group.
Key findings
01Early rehabilitation and longer daily duration were associated with improved activities of daily living in patients requiring pre-admission assistance.
02The benefit of early rehabilitation disappeared for patients with the highest pre-admission disability scores (mRS 5).
03Increasing the duration of rehabilitation per day improved activities of daily living across all levels of pre-admission disability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The database covers only 55% of hospitalized patients in Japan, excluding many community hospitals. There was 20.8% missing data for the primary outcome, which was handled using multiple imputation. The study could not distinguish between high-frequency short sessions and low-frequency long sessions because it only recorded total daily hours. Results reflect inpatient acute care outcomes only; effects after transfer to rehabilitation hospitals or outpatient care were not measured. Lack of data on stroke location and severity may have left some confounding factors unadjusted.
The easy way to misread this
Do not assume that starting rehabilitation within the first three days is universally beneficial for all stroke patients who were previously disabled. The study found no significant functional improvement from early rehabilitation in the most severely dependent group (mRS 5), so timing decisions should consider the patient's pre-admission physical status.