Association between Care-need Level after Discharge and Long-term Outcomes in 7491 Patients Requiring Rehabilitation for Stroke

Abstract

Introduction: Stroke is a major cause of disability and mortality worldwide and requires long-term care, including rehabilitation. This study aims to elucidate the association between care-need levels after discharge and long-term outcomes in patients with stroke. Methods: We used a Japanese administrative database that covers both medical and long-term care insurance systems to retrospectively identify 7491 patients who underwent acute-phase in-hospital rehabilitation for stroke between June 2014 and February 2019. We investigated the association between nationally standardized care-need levels (support levels 1-2 and care-need levels 1-3) 6 months after discharge and long-term outcomes. Using the Fine-Gray model, we conducted multivariable survival analysis with adjustment for patient backgrounds and treatment courses to estimate hazard ratios (HR) for mortality and the incidence of being bedridden. Results: The median age was 82 (interquartile range [IQR], 76-87) years, 5418 patients (72%) had cerebral infarction, and 4009 patients (54%) had partial dependence after discharge. During a median follow-up of 580 (IQR, 189-925) days, 1668 patients (22%) became bedridden, and 2174 patients (29%) died. Compared with patients with support level 1, those with higher care-need levels showed significantly higher proportions of being bedridden―the subdistribution HR [95% confidence interval] were 1.52 [1.10-2.12], 2.85 [2.09-3.88], and 3.79 [2.79-5.15] in those with care-need levels 1, 2, and 3, respectively. Higher care-need levels were also significantly associated with higher mortality. Conclusions: This large-scale observational study demonstrated that a higher level of care-need after discharge was significantly associated with poorer functional outcomes and higher mortality.

Assessing care dependence status and associated influencing factors among middle‐aged hemiplegic stroke patients during the post‐acute rehabilitation phase: A correlational study

“…This concept encompasses domains such as mobility, dressing, toileting and communication, revealing elevated rates of functional dependence during the post-acute stroke stage and acting as an indicator for survival prognosis (Sennfält et al, 2019). Multiple studies have robustly established a substantial correlation between care dependence and mortality among stroke survivors during the rehabilitation phase (Junttola et al, 2022;Konishi et al, 2024). This correlation highlights that stroke survivors with a higher level of care need after discharged or during post-acute rehabilitation stage face an increased risk of poorer functional outcomes and higher mortality.…”

Transition experiences of patients with post stroke dysphagia and family caregivers: A longitudinal, qualitative study

“…In addition, there is an unmet need for oral feeding skills, rehabilitation training methods, and assessment of nutritional status [ 10 ]. And the level of patients’ care needs is closely related to mortality and prognosis [ 11 ]. Consequently, exploring patients’ rehabilitation care needs plays a key role in facilitating their recovery.…”

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“…In addition, there is an unmet need for oral feeding skills, rehabilitation training methods, and assessment of nutritional status [10]. And the level of patients' care needs is closely related to mortality and prognosis [11]. Consequently, exploring patients' rehabilitation care needs plays a key role in facilitating their recovery.…”