Rehabilitation Reduced Readmission and Mortality Risks in Patients With Stroke or Transient Ischemic Attack
| Autor: | Yu Ching Huang, Hsuei Chen Lee, Jen Wen Hung, Hui-Hsuan Wang, Chung Lin Yang, Chu Ling Yen, Ku Chou Chang, Ching-yi Wu, Pei Li Lin |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Research design medicine.medical_specialty medicine.medical_treatment Taiwan Lower risk Patient Readmission 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Risk of mortality medicine Humans In patient 030212 general & internal medicine Stroke Aged Retrospective Studies Aged 80 and over Rehabilitation business.industry Hazard ratio Stroke Rehabilitation Public Health Environmental and Occupational Health Retrospective cohort study Length of Stay Middle Aged medicine.disease Ischemic Attack Transient Female business 030217 neurology & neurosurgery |
| Zdroj: | Medical Care. 56:290-298 |
| ISSN: | 0025-7079 |
| DOI: | 10.1097/mlr.0000000000000888 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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