High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study

Abstract

Background and Objectives: Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. Materials and Methods: Data of patients diagnosed with stroke between 2000 and 2012 were collected from the 2000 Longitudinal Health Insurance Database (Taiwan). Based on the number of rehabilitation sessions attended within 90 days of discharge, the rehabilitation intensity was classified as low, medium, or high. After adjusting for sociodemographic factors and comorbidities, the Cox proportional hazards model evaluated the risk of PU development during the 12-year follow-up period. Kaplan–Meier curves were used to estimate the cumulative incidence of PUs. Results: Our study included 18,971 patients who had their first episode of stroke. Of these, 9829 (51.8%) underwent rehabilitation therapy after discharge. Female patients and patients with a National Institutes of Health Stroke Scale (NIHSS) score >13 points, who commenced high-intensity post-stroke rehabilitation after discharge had a significantly lower risk of PU development than those who underwent low-intensity post-stroke rehabilitation after discharge. Cumulative survival analysis showed a significantly lower cumulative incidence of PU during the 12-year follow-up period in the high-intensity rehabilitation group. Conclusion: Compared with low-intensity post-stroke rehabilitation, high-intensity post-stroke rehabilitation after discharge from hospital is associated with a lower risk of post-stroke PU development, especially in female stroke patients and patients with a NIHSS score >13 points. High-intensity rehabilitation is also associated with a significantly lower cumulative incidence of PU events during the 12-year follow-up period.

Comparative analysis of pressure ulcer development in stroke patients within and outside healthcare facilities: A systematic review and meta‐analysis

“…The higher prevalence in the non‐medical service group suggests a need for targeted interventions. This includes enhancing home healthcare services, increasing patient and caregiver education about pressure injury prevention, and improving access to medical resources 27,28 . For patients with access to medical services, the emphasis should be on maintaining the quality of care and ensuring consistent implementation of best practices for pressure injury prevention and management.…”

Relationship between Nutritional Risk, Clinical and Demographic Characteristics, and Pressure Ulcers in Patients with Severe Acquired Brain Injuries Attending a Rehabilitative Program

“…Previous research findings concerning the length of stay in ICU and PUs were contradictory [30]. Actually, ICU stay implies limited movements and restricted positions, which are well-known major risk factors for PU onset [30], while stroke patients are at higher risk of immobility-related complications due to cognitive, functional, and sensory deficits [31]. A significant relationship between immobility and PU onset was reported, with a significant association between FIM score at admission and PU onset during hospitalization [31], confirming a protective role of rehabilitation to recover mobility and improve functionality.…”

The effects of evidence‐based nursing interventions on pressure ulcers in patients with stroke: a meta‐analysis

“…Due to long‐term bed rest, limb paralysis and urinary and faecal incontinence, among other factors, most patients with stroke are at increased risk of developing pressure ulcers 34 . Once formed, pressure ulcers not only increase patient suffering, but also prolong hospital stay and impose a heavy financial burden on families 35 . Therefore, effective clinical interventions are needed to prevent and reduce the incidence of pressure ulcers among patients with stroke 36…”

“…34 Once formed, pressure ulcers not only increase patient suffering, but also prolong hospital stay and impose heavy financial burden on families. 35 Therefore, effective clinical interventions are needed to prevent and reduce the incidence of pressure ulcers among patients with stroke. 36 The results of this meta-analysis showed that evidence-based nursing interventions, which provide targeted and medically justified nursing measures, can not only reduce the incidence of pressure ulcers in patients with stroke, but also delay the time to occurrence, and improve patient satisfaction and quality of life.…”