Rehabilitation Reduced Readmission and Mortality Risks in Patients With Stroke or Transient Ischemic Attack: A Population-based Study. Issue 4 (April 2018) - Chang, Ku-Chou
Abstract : Background: It remains unclear whether rehabilitation has an impact on reducing the long-term risk of mortality or readmission following stroke or transient ischemic attack (TIA). Objectives: To investigate the association between the dosage and continuation of rehabilitation and the risk of outcome events (OEs) after stroke or TIA. Research Design: A retrospective cohort study using Taiwan's National Health Insurance database. Subjects: In total, 4594 patients admitted with first-ever acute stroke or TIA were followed-up for 32 months. Measures: The occurrence of 3 OEs: (1) vascular readmissions/all-cause mortality [vascular event (VE)], (2) all-cause readmissions/mortality (OE1), and (3) all-cause mortality (OE2), in model 1: none, low-intensity, and high-intensity rehabilitation; and model 2: inpatient plus/or outpatient rehabilitation. Results: Comparing with patients without rehabilitation, in model 1, patients receiving low-intensity rehabilitation had a lower risk of VE [Hazard ratio (HR), 0.77; 95% CI, 0.68–0.87] and OE1 (HR, 0.77; CI, 0.71–0.84), but not OE2 (HR, 0.91; CI, 0.77–1.07). Patients receiving high-intensity rehabilitation had lower risks of all VE (HR, 0.68; CI, 0.58–0.79), OE1 (HR, 0.79; CI, 0.71–0.88), and OE2 (HR, 0.56; CI, 0.44–0.71). In model 2, patients receiving inpatient plus outpatient rehabilitation had a lowest risk of VE (HR, 0.55; CI, 0.47–0.65), OE1 (HR, 0.65; CI, 0.58–0.72), and OE2 (HR, 0.45; CI, 0.35–0.59). Sensitivity analysis with TIA excluded rendered the similar trend. Subgroup analyses found that the positive effect was not demonstrated in hemorrhagic stroke patients. Conclusions: Rehabilitation use was associated with reduction of readmissions/mortality risks following stroke or TIA. The optimal intensity and duration of rehabilitation and the discrepancy shown in hemorrhagic stroke need further clarification. Abstract : Supplemental Digital Content is available in the text.