Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Kamo, Tomohiko; Momosaki, Ryo; Suzuki, Keisuke; Asahi, Ryoma; Azami, Masato; Ogihara, Hirofumi; Nishida, Yukio

doi:10.1016/j.jstrokecerebrovasdis.2019.06.007

Cited by 23 publications

(18 citation statements)

References 23 publications

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“…The intensity of rehabilitation increased significantly after April 2011 and was equivalent to the high-intensity rehabilitation reported in previous studies. 14 Contrary to our hypothesis, rehabilitation intensity did not impact medical costs or the readmission ratio during the first year after discharge. These results suggest that even if rehabilitation intensity was high, medical costs after discharge were not reduced and the readmission ratio did not decrease.…”

Section: Discussioncontrasting

confidence: 85%

“…Hsieh et al 7 considered high-intensity rehabilitation to be 15 sessions or more within 90 days, Liu et al 9 considered 3 hours or more in a community setting (total therapy hours divided by total number of therapy sessions), and Jette et al 12 considered 1.5 hours or more per day. Furthermore, similar to the present study, for the convalescent rehabilitation unit, Kamo et al 14 reported that high-intensity rehabilitation group was defined as stroke patients who received more than 15 hours of rehabilitation therapy per week (!15 hours). In this study, we defined the high-intensity group as patients admitted to the hospital after April 2011 (in which case the hospital obtains additional insurance medical fee for more than 120 minutes/d of rehabilitation).…”

Section: Discussionsupporting

confidence: 54%

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Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

Nagayama

Tomori

Ikeda

et al. 2021

Journal of the American Medical Directors Association

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Objectives: This study examined the association between intensive rehabilitation for subacute stroke patients and medical costs and readmission ratio during the year after discharge. Design: This was a natural experiment study. Setting and Participants: We identified individuals with a diagnosis of cerebrovascular disorder (ICD-10: I60-I69 cerebrovascular disease) in an insurance claims database in Japan from January 2005 to December 2017. From the database, 980 patients who were admitted to a convalescent rehabilitation unit with stroke were identified. After excluding 575 patients, 405 were eligible for the study. Methods: In Japan, from April 2011, a new policy was established that allows special costs to be added as rehabilitation time increases. This policy provides an additional medical fee for inpatients in a convalescent rehabilitation unit who receive more than 120 minutes of rehabilitation therapy. We defined high-intensity rehabilitation as transfer from hospitalization to a convalescent rehabilitation unit after April 2011. Outcomes were total direct medical costs and readmission ratio during the year after discharge from the convalescent rehabilitation unit. Results: Daily rehabilitation time, total rehabilitation time, and total medical costs of the high-intensity rehabilitation group were significantly higher than those of the low-intensity rehabilitation group (P < .001, P < .001, P ¼ .011, respectively). However, there was no significant difference in the medical costs during the year after discharge (P ¼ .653) or in the readmission ratio (hazard ratio: 1.09, 95% confidence interval: 0.55-2.18, P ¼ .804). Conclusions and Implications: Intensive rehabilitation did not reduce medical costs or the readmission ratio during the first year after discharge. Future studies should consider the necessary rehabilitation intensity given the severity of the patient's condition, using large sample sizes.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionsupporting

confidence: 54%

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

Nagayama

Tomori

Ikeda

et al. 2021

Journal of the American Medical Directors Association

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“…Early commencement of rehabilitation after stroke is recommended in many clinical practice guidelines (Belagaje 2017;Bernhardt et al 2017;Coleman et al 2017). Moreover, in the medical cooperation system in Japan, intensive rehabilitation therapy is reported to lead to preferable functional outcomes after stroke in convalescent rehabilitation wards (Kamo et al 2019), where intensive and comprehensive multidisciplinary inpatient rehabilitation is performed (KRWA 2016). To make progress in this field, we aimed to determine whether the onset-admission interval had any associations with the rehabilitation outcomes in this setting.…”

Section: Discussionmentioning

confidence: 99%

Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients

Yoshimura¹,

Wakabayashi

Momosaki

et al. 2020

Tohoku J. Exp. Med.

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As Japan's population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10][11][12][13][14][15][16][17][18][19][20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (β = −0.107, p = 0.024), FILS score at discharge (β = −0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

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“…The goal of therapeutic rehabilitation is to help the patients return to a level of normalcy, to survive, and to improve on the skills needed in everyday life. This form of therapy includes their physical, mental, and cognitive abilities [23]. Previous research states that the knowledge possessed by the nurses is very important in order for them to be able to provide interventions and therapeutic approaches to schizophrenia patients [24], [25], [26].…”

Section: Discussionmentioning

confidence: 99%

Description the Importance of Developing a Self-Reliance Instrument for Schizophrenic Patients in the Hospital Setting

Nihayati

Fitriyasari

Tristiana

et al. 2021

Open Access Maced J Med Sci

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Abstract Background: The level of independence among schizophrenia patients is still a problem that must be resolved. The development of appropriate relevant instruments is needed. This study aims to develop a nursing rehabilitation therapy instrument to increase the independence of schizophrenia patients in the hospital setting. Methods: This study used a research and development study design. The study was conducted in a Psychiatric Hospital in Surabaya, Indonesia from August to December 2020. The total sample in this study consisted of 100 nurses determined by a simple random sampling technique. In addition, 50 medical records were observed. The inclusion criteria were nurses who cared for patients with schizophrenia with a minimum work experience of 1 year. Respondents were excluded from the study if they did not follow the study through to completion. The data collection process was done online by filling in a Google form. The data was analysed using descriptive statistics and a FGD followed with 10 nurses to discuss the new instrument. Results: The data found that a rehabilitation therapy instrument is not currently available (53%). The FGD results show that it is necessary to develop the nurse’s knowledge and to provide adequate facilities and rooms, as well as to develop instruments to use as measuring tools in order to evaluate the rehabilitation therapy given. Conclusion: Rehabilitation therapy instruments are important to develop for schizophrenia patients. It is hoped that the development of the instrument in this study will optimise the rehabilitation of schizophrenia patients.

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Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Cited by 23 publications

References 23 publications

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data

Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients

Description the Importance of Developing a Self-Reliance Instrument for Schizophrenic Patients in the Hospital Setting

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