Rehabilitation Reduced Readmission and Mortality Risks in Patients With Stroke or Transient Ischemic Attack: A Population-based Study

• Published in: Medical care 2018-04, Vol.56 (4), p.290-298
• Main Authors: Chang, Ku-Chou, Hung, Jen-Wen, Lee, Hsuei-Chen, Yen, Chu-Ling, Wu, Ching-Yi, Yang, Chung-Lin, Huang, Yu-Ching, Lin, Pei-Li, Wang, Hui-Hsuan
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Health insurance; Health risks; Hemorrhage; Humans; Ischemia; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - rehabilitation; Length of Stay; Male; Mental health; Middle Aged; Mortality; Neurological disorders; Patient Readmission - statistics & numerical data; Patients; Population studies; Population-based studies; Public health; Rehabilitation; Research design; Retrospective Studies; Risk Factors; Sensitivity analysis; Stroke; Stroke - mortality; Stroke Rehabilitation - statistics & numerical data; Subgroups; Taiwan; Transient ischemic attack
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000888

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 1none, low-intensity, and high-intensity rehabilitation; and model 2inpatient 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.