Impact of rehabilitation intensity on mortality risk after stroke

Publication date: Available online 3 November 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cheng-Yang Hsieh, Hsiu-Chen Huang, Darren Philbert Wu, Chung-Yi Li, Meng-Jun Chiu, Sheng-Feng Sung
ObjectiveTo determine the relationship between rehabilitation intensity and post-stroke mortality.DesignRetrospective cohort study.Setting: Nationwide claims data.ParticipantsFrom Taiwan's National Health Insurance claims databases, a total of 6737 patients (mean age 66.9 years; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.InterventionThe intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the amount of rehabilitation sessions.Main Outcome MeasuresLong-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.ResultsPatients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.63–0.84) of mortality compared with the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR 0.94, 95% CI 0.84–1.06) to the low-intensity group. This association was not modified by stroke severity.ConclusionsAmong stroke patients with mild to moderate severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk compared to low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of stroke patients should be encouraged.



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