Abstract
Objective
To assess the long-term health outcomes of acute stroke survivors transferred to the
rehabilitation ward.
Design
Long-term mortality rates of first-time stroke survivors during hospitalization were
compared among the following sets of patients: patients transferred to the rehabilitation
ward, patients receiving rehabilitation without being transferred to the rehabilitation
ward, and patients receiving no rehabilitation.
Setting
Retrospective cohort study.
Participants
Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility.
After propensity score matching, 390 first-time stroke survivors were included.
Interventions
None.
Main Outcome Measure
Cox proportional hazards regression model was used to assess differences in 5-year
poststroke mortality rates.
Results
Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without
being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval
[CI], 1.36–3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95%
CI, 2.55–6.27) had significantly higher mortality risk than the patients transferred
to the rehabilitation ward. Mortality rate of the stroke survivors was affected by
age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR,
1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity
Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity
(Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted
HR, 4.23).
Conclusions
First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality
rate 2.2 times lower than those who received rehabilitation without transfer to the
rehabilitation ward and 4 times lower than those who received no rehabilitation.
Keywords
List of abbreviations:
CCI (Charlson-Deyo Comorbidity Index), CI (confidence interval), HR (hazard ratio), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), NHI (National Health Insurance), NHIRD (National Health Insurance Research Database), SSI (Stroke Severity Index)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Selecting measures for balance and mobility to improve assessment and treatment of individuals after stroke.Top Stroke Rehabil. 2014; 21: 303-315
- Epidemiology and disease burden of ischemic stroke in Taiwan.Int J Neurosci. 2013; 123: 724-731
- Incidence of stroke in Taiwan.Stroke. 1992; 23: 1237-1241
- Prevalence of stroke in Taiwan.Stroke. 1989; 20: 858-863
- The impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients.J Chin Med Assoc. 2009; 72: 257-264
- Cost-effectiveness analysis of stroke management under a universal health insurance system.J Neurol Sci. 2012; 323: 205-215
- Inpatient rehabilitation utilization for acute stroke under a universal health insurance system.Am J Manag Care. 2010; 16: e67-e74
- Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in Taiwan.J Rural Health. 2012; 28: 84-91
- An exploration of the association between very early rehabilitation and outcome for the patients with acute ischaemic stroke in Japan: a nationwide retrospective cohort survey.BMC Health Serv Res. 2010; 10: 213
- Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study.Stroke. 1999; 30: 930-933
- Stroke rehabilitation and risk of mortality: a population-based cohort study stratified by age and gender.J Stroke Cerebrovasc Dis. 2015; 24: 1414-1422
- When should physical rehabilitation commence after stroke: a systematic review.Int J Stroke. 2014; 9: 468-478
- The central role of the propensity score in observational studies for causal effects.Biometrika. 1983; 70: 41-55
- Incorporating developmental stratification of Taiwan townships into sampling design of large scale health interview survey.J Health Manage. 2006; 4: 1-22
- Developing a stroke severity index based on administrative data was feasible using data mining techniques.J Clin Epidemiol. 2015; 68: 1292-1300
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Applied logistic regression.John Wiley & Sons, New York1989
- Porta M. A dictionary of epidemiology. 6th ed. Oxford University Press, New York2014
- Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.Arch Phys Med Rehabil. 2014; 95: 269-275
- Functional gain after inpatient stroke rehabilitation: correlates and impact on long-term survival.Stroke. 2015; 46: 2976-2980
- Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain.Health Qual Life Outcomes. 2015; 13: 36
- Cause-specific mortality after first cerebral infarction: a population-based study.Stroke. 2003; 34: 1828-1832
- Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?.Arch Phys Med Rehabil. 2008; 89: 1903-1906
- Five-year mortality and related prognostic factors after inpatient stroke rehabilitation: a European multi-centre study.J Rehabil Med. 2012; 44: 547-552
- Long-term outcome in stroke survivors after discharge from a convalescent rehabilitation ward.Psychiatry Clin Neurosci. 2013; 67: 434-440
- Stroke discharges from a rehabilitation unit: 1-year and 5-year domicile outcomes. Function is important.Intern Med J. 2010; 40: 45-51
- Implications of female sex on stroke risk factors, care, outcome and rehabilitation: an Asian perspective.Cerebrovasc Dis. 2015; 39: 302-308
- Long-term mortality in cerebrovascular disease.Stroke. 2003; 34: 699-704
- Early and delayed fatality of stroke in Kolkata, India: results from a 7-year longitudinal population-based study.J Stroke Cerebrovasc Dis. 2013; 22: 281-289
- Long-term mortality after stroke among adults aged 18 to 50 years.JAMA. 2013; 309: 1136-1144
- Short-term, intermediate-term, and long-term mortality in patients hospitalized for stroke.J Clin Epidemiol. 2003; 56: 81-87
- The association between rural residence and stroke care and outcomes.J Neurol Sci. 2016; 363: 16-20
- Socioeconomic deprivation and mortality in people after ischemic stroke: The China National Stroke Registry.Int J Stroke. 2016; 11: 557-564
Article info
Publication history
Published online: April 20, 2017
Footnotes
This work was based on the National Health Insurance Research Database provided by the Central Bureau of National Health Insurance, the Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
