Safety and Effectiveness of Early Rehabilitation in Patients With Stroke and Concomitant Kidney Disease: A Cohort Study With Claims Data.
Takuaki Tani, Kiyohide Fushimi, Shinobu Imai
PMID 40678289WHAT IT FOUND
Starting rehabilitation 24 to 48 hours after admission did not increase death rates or shorten hospital stays compared to starting later.
The primary outcome was null for both chronic kidney disease and end-stage kidney disease groups.
Key findings
01Early rehabilitation was not associated with mortality in patients with chronic kidney disease or end-stage kidney disease.
02There was no significant difference in length of stay or improvement in activities of daily living between early and usual care groups.
03In a follow-up analysis extending observation to 180 days, early rehabilitation was associated with reduced mortality risk in patients with chronic kidney disease.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study used administrative claims data, so it could not determine the time from stroke onset to rehabilitation, only from admission. It could not account for stroke severity factors like infarct location, which may have influenced who received early rehabilitation. The data did not specify the type of rehabilitation provided, only that it was standardized. It is unclear why some patients did not receive early rehabilitation, whether due to clinical instability or service unavailability. The 90-day observation period may have been too short to capture differences in functional recovery, which typically occur between 60 and 90 days post-stroke.
Declared interests
The authors declare no competing interests.
The easy way to misread this
Do not assume early rehabilitation improves function or shortens stays. The primary outcomes were null, and the mortality benefit seen at 180 days was a secondary analysis that did not apply to patients with end-stage kidney disease.