Post-ischemic stroke rehabilitation is associated with a higher risk of fractures in older women: A population-based cohort study

Huang, Huei‐Kai; Lin, Shu‐Man; Yang, Clement Shih Hsien; Liang, Chung Chao; Cheng, Hung Yu

doi:10.1371/journal.pone.0175825

Cited by 9 publications

(8 citation statements)

References 74 publications

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“…Otherwise, females have much higher prevalence of osteoporosis in our as well as in other studies. The high osteoporosis prevalence of elder women needs special attention as only older women showed a 60% higher risk of fractures during post-ischemic stroke neurorehabilitation ( Huang et al, 2017 ). Thus, altogether, regular post-stroke screening for osteoporosis and appropriate management is recommended in both men and women.…”

Section: Discussionmentioning

confidence: 99%

Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation

Kautzky‐Willer

Harreiter

Thomas

et al. 2021

Front. Aging Neurosci.

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Objective: Little is known about possible sex and gender differences in post-stroke neurorehabilitation outcomes. We aimed to analyze if functional performance, prevalence and impact of comorbidities at admission, and success of inpatient stroke-neurorehabilitation differ between men and women.Methods: Retrospective cohort analysis of 1,437 men and 907 women with prior cerebral infarction treated at a neurorehabilitation clinic between 2012 and 2017; multiple linear regression was used to examine the influence of sex/gender as well as multiple confounders on health and functional outcomes. The main outcome measures were Barthel index (BI) at admission and its change during 4 weeks inpatient neurorehabilitation.Results: Men had been diagnosed with osteoporosis less frequently than women but more often with type 2 diabetes mellitus, coronary artery or chronic kidney disease (p ≤ 0.01). Although twice as many women presented with pre-stroke depression compared to men, the risk of post-stroke depression detected during rehabilitation was comparable. Men were more likely to have less than 30 days between diagnosis and neurorehabilitation start than women (p < 0.03). At admission, women exhibited less autonomy, a lower BI, a higher pain score and worse 2-min walk test (2′WT) compared to men (p < 0.001). Among males osteoporosis and peripheral artery disease independently predicted BI at admission, in women it was pre-stroke depression, dementia, and arterial fibrillation. During neurorehabilitation, both sexes improved regarding BI, pain and walk tests (p < 0.001). Despite comparable rehabilitation effectiveness, women still had worse functional outcomes than males at discharge. Time after stroke to start of neurorehabilitation and length of the stay but, most strongly, the simple 2′WT at admission, and in women, pain intensity independently predicted post-stroke functional status and recovery.Conclusion: Women presented with worse functional status at admission to neurorehabilitation. Although men and women showed similar rehabilitation effectiveness, women still displayed worse clinical outcome measures and higher levels of pain at discharge. Early access and gender-sensitive, personalized post-stroke care with more focus on different comorbidities and psychosocial factors like pain levels and management, could further improve neurorehabilitation outcomes.

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Section: Discussionmentioning

confidence: 99%

Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation

Kautzky‐Willer

Harreiter

Thomas

et al. 2021

Front. Aging Neurosci.

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“…No statistically significant differences were found in the ages, sex or healthcare costs between the one million individuals in the longitudinal database and all NHI beneficiaries. By linking ambulatory and inpatient care claims and the registry of beneficiaries, information about patient demographics and medical records was obtained from the longitudinal database, and used for data analysis 32. The data set, which consists of de-identified secondary data for research purposes, was released by the NHI Bureau, and therefore written consent from study subjects was not possible to be obtained.…”

Section: Methodsmentioning

confidence: 99%

“…The study patients were selected on the basis of primary discharge diagnosis of ischaemic stroke (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 433 and 434). We defined the concurrent hospitalisation and the date of new-onset stroke, respectively, as the index hospitalisation and the index date, in accordance with our earlier study 32. The exclusion criteria were as follows: (1) age <20 years; (2) history of stroke before the year 2000; (3) history of hip fracture before the index date; (4) simultaneous hip fracture diagnosis during index hospitalisation; and (5) mortality during index hospitalisation.…”

Section: Methodsmentioning

confidence: 99%

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

et al. 2017

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ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

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“…(5) withdrew from the insurance program before diagnosed with stroke. These codes were used in previous epidemiologic studies that employed the LHID [16][17][18] (Figure 1).…”

Section: Study Populationmentioning

confidence: 99%

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

Chen

Cheng

et al. 2022

Medicina

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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.

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Post-ischemic stroke rehabilitation is associated with a higher risk of fractures in older women: A population-based cohort study

Cited by 9 publications

References 74 publications

Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation

Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation

Thiazide diuretics and the risk of hip fracture after stroke: a population-based propensity-matched cohort study using Taiwan’s National Health Insurance Research Database

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

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