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Chronic Phase Survival Rate in Stroke Patients With Severe Functional Limitations According to the Frequency of Rehabilitation Treatment

  • Dougho Park
    Affiliations
    From the Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
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  • Kang Ju Son
    Affiliations
    Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea

    Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea
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  • Hyoung Seop Kim
    Correspondence
    Corresponding author Hyoung Seop Kim, MD, PhD, Department of Rehabilitation, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang 10444, Republic of Korea.
    Affiliations
    Department of Rehabilitation Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Published:September 07, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.973

      Abstract

      Objective

      To investigate the chronic phase survival rate according to the frequency of rehabilitation treatment in the acute and subacute phases in stroke patients with severe functional limitations.

      Design

      A retrospective longitudinal cohort study.

      Setting

      Population-based study using the Korean National Health Insurance Database from 2007 to 2018.

      Participants

      We enrolled 593 patients who experienced stroke in 2009 with national disability registration (NDR) grade of 3 or less (N=593).

      Intervention

      Not applicable.

      Main Outcome Measures

      The frequencies of rehabilitation treatment within 24 months after stroke were categorized into none, 1-50, 51-200, 201-400, and >400 treatments based on requests made to the Health Insurance Review and Assessment Service. As a dependent variable, we assessed all-cause mortality from 24 to 120 months after stroke.

      Results

      The study enrolled 283 patients in NDR grade 1 (the most severe), 158 in grade 2, and 152 in grade 3. Groups with more severe functional limitations showed a lower chronic phase survival rate (P<.001). The groups with higher frequencies of rehabilitation treatment in the acute and subacute phases showed a higher chronic phase survival rate (P<.001). In the Cox regression analysis, a higher degree of functional limitation, lower frequency of rehabilitation treatment, older age, male sex, and chronic kidney disease were independent risk factors for chronic phase mortality in stroke patients with severe functional limitations.

      Conclusions

      A high frequency of rehabilitation treatment in the acute and subacute phases was associated with the long-term survival of stroke patients with severe functional limitations.

      Keywords

      List of abbreviations:

      aHR (adjusted hazards ratio), CI (confidence interval), HIRA (Health Insurance Review and Assessment), NDR (National Disability Registration), NHIP (National Health Insurance Premium), NHIS (National Health Insurance System)
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