Original research| Volume 98, ISSUE 12, P2399-2407, December 2017

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study

  • Chien-Min Chen
    Corresponding author Chien-Min Chen, MD, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No 6, W Sec, Jiapu Rd, Puzih City, Chiayi County 613, Taiwan.
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan

    School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Yao-Hsu Yang
    Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

    Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan

    School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Chia-Hao Chang
    Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
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  • Pau-Chung Chen
    Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

    Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Published:April 20, 2017DOI:



      To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward.


      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.


      Retrospective cohort study.


      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.



      Main Outcome Measure

      Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates.


      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).


      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.


      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)
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