Impact of Rehabilitation on Outcomes in Patients With Ischemic Stroke

Yagi, Masayuki; Yasunaga, Hideo; Matsui, Hiroki; Morita, Kojiro; Fushimi, Kiyohide; Fujimoto, Masashi; Koyama, Takeo; Fujitani, Junko

doi:10.1161/strokeaha.116.015147

Cited by 138 publications

(94 citation statements)

References 31 publications

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“…Early rehabilitation with mobilization out of bed during hospitalization has shown to be associated with better functional outcomes for patients after stroke [4–8]. This may reduce the loss of muscle mass, increase muscle strength [6, 9], avoid complications [3, 4, 10], exploit the plasticity of the brain [11], improve neurological functioning [12], and improve gait function [13].…”

Section: Introductionmentioning

confidence: 99%

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study

et al. 2018

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BackgroundEarly mobilization has been an important part of acute stroke unit treatment. However, early and intense mobilization within the first 24 h post stroke may cause an unfavorable outcome. Recently, objective measurements using body-worn sensors have been applied, enabling continuous monitoring of physical activity in the hospital setting. This study aimed to use body-worn sensors to quantify the amount of physical activity and how activity levels changed over time during hospitalization in patients with acute stroke. We also wanted to investigate which factors were associated with upright and sitting activity.MethodsThis was a prospective study including patients admitted to hospital within seven days after onset of stroke. Physical activity was measured by two sensors (ActivPALs from PAL Technologies Ltd., Glasgow, UK), one attached on sternum and one on the thigh of the unaffected side, monitoring continuously from inclusion until discharge. Data were processed in Matlab R 2015B and provided information about daily time in lying, sitting, and upright positions, and daily average duration of sitting and upright bouts. A linear mixed model was used to analyze changes over time.Results58 patients were included (31 women, mean (SD) age; 75.1 (12.0)). Patients were hospitalized for 12.1 (7.6) days and had a mean score on the National Institute of Health Stroke Scale of 6.2 (5.5) points. Time spent sitting and time spent upright increased per day during hospitalization by 22.10 min (95% Confidence interval (CI): 14.96, 29.24) and 3.75 min (95% CI: 1.70, 5.80) respectively. Increased time upright was associated with improved Modified Rankin Scale scores (− 38.09 min, 95% CI: -61.88, − 14.29) and higher Short Physical Performance Battery scores (6.97 min, 95% CI: 1.99, 11.95), while prolonged bouts of sitting were associated with more severe stroke (4.50 min, 95% CI: 0.80, 8.19), and older age (1.72 min, 95% CI: 0.20, 3.26).ConclusionsPatients increased their daily time spent sitting and upright during the initial hospital stay after stroke. Prolonged bouts of sitting were associated with older age and more severe strokes. Hence future research should investigate the benefit of interventions aimed at breaking up sitting time after stroke.

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Section: Introductionmentioning

confidence: 99%

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study

et al. 2018

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“…In Japan, however, the average LOS for inpatient rehabilitation is much longer. Patients who require long-term rehabilitation in Japan might be transferred to a hospital rehabilitation program up to 150 days in duration [ 32 ]. Theoretically, the per-diem reimbursement method should reduce daily expenditures even if hospital LOS is increased [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching

Wang

Miyoshi²,

Chen

et al. 2020

Aging

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Few studies have compared how rehabilitative post-acute care affects recovery of walking ability and other functions after stroke in different age groups. After propensity score matching (1:1), 316 stroke patients were separated into an aged group (age ≥65 years, n=158) and a non-aged group (age <65 years, n=158). Both groups significantly improved in Barthel index, EuroQol-5 dimension, Berg balance scale, 6-minute walking distance and 5-meter walking speed ( P <0.001). The non-aged group had significantly larger improvements in Berg balance scale, instrumental activities of daily living, EuroQol-5 dimension and 6-minute walking distance ( P <0.001) compared to the aged group. The two groups did not significantly differ in Barthel index, 5-meter walking speed, length of stay, and cost. The aged group had poorer walking ability and poorer instrumental activities of daily living compared to the non-aged group. After intensive rehabilitative post-acute care, however, the aged group improved in walking ability, functional performance and mental health. Intensive strength training for unaffected lower limbs in the stroke patients achieved good recovery of walking ability and other functions. Overall, intensive rehabilitative post-acute care improved self-care ability and decreased informal care costs. Rehabilitative PAC under per-diem reimbursement is efficient and economical for stroke patients in an aging society.

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“…As was previously stated, stroke survivors need formal and informal care even after they have been discharged home from the rehabilitation hospital (Jackson et al, ). Even though the rehabilitation provided in the hospitals allows them to achieve good outcomes to better perform the ADL (Yagi et al, ), survivors still have care needs following home discharge (Tistad & von Koch, ).…”

Section: Introductionmentioning

confidence: 99%

Formal and informal care after stroke: A longitudinal analysis of survivors’ post rehabilitation hospital discharge

Pucciarelli

Ausili

Rebora

et al. 2019

Journal of Advanced Nursing

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Aims To describe the type and the amount of formal and informal care received during the first year after home discharge and to identify the baseline predictors of the formal and informal care needs of stroke survivors. Design Longitudinal study. Data were collected between June 2013–May 2016. Methods Survivors (N = 415) were enrolled during discharge from rehabilitation hospitals and interviewed at 3 (T1), 6 (T2), 9 (T3), and 12 (T4) months. The linear mixed effects model with random intercept and random slopes was used to trend for the amount of formal and informal care received by survivors during the four observation times. Results Regarding formal care, only physiotherapy and speech therapy decreased significantly over time. Stroke survivors received a mean of 17 hr of paid informal care per week at T1 and these hours did not significantly decrease after one year from discharge, while unpaid informal care decreased significantly over time. Higher numbers of paid informal caregiving were predicted by older age, higher education levels, lower physical functioning, and living without unpaid informal caregivers while higher numbers of unpaid informal care were predicted by lower physical functioning and living with unpaid informal caregivers. Conclusions Stroke has a great effect on survivors’ lives. During the first few months after rehabilitation hospital discharge, survivors need further care because they are often discharged before achieving independent functioning. Impact The results of this study could be important to guide future interventions aimed at imporving stroke survivors' conditions after post rehabilitation hospital discharge.

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Impact of Rehabilitation on Outcomes in Patients With Ischemic Stroke

Cited by 138 publications

References 31 publications

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study

Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching

Formal and informal care after stroke: A longitudinal analysis of survivors’ post rehabilitation hospital discharge

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