Cheng Yuan-Yang, Shu Jiah-Hwang, Hsu Hsiu-Chuan, Liang Ying, Chang Shin-Tsu, Kao Chung-Lan, Leu Hsin-Bang
Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.
J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2755-2762. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.047. Epub 2017 Jul 29.
Rehabilitation is essential for all poststroke patients to improve self-care ability. However, whether an increased frequency of rehabilitation reduces poststroke adverse events remains undetermined.
We recruited 4899 patients with newly diagnosed ischemic stroke between January 1, 2000, and December 31, 2008, from our database and divided them into 3 groups according to their Charlson Comorbidity Index, and they were further categorized into 3 groups of different rehabilitation frequencies during their first year after stroke. Clinical adverse events including recurrent stroke, hip fracture, pneumonia, and all-cause mortality were analyzed by Cox regression analysis to investigate the protective effects of aggressive rehabilitation.
We discovered that aggressive rehabilitation in the first year after stroke was significantly associated with a lower incidence of recurrent stroke and all-cause mortality despite the severity of patients' comorbidities. Further Cox regression analysis revealed decreased hazard ratios to develop recurrent stroke and all-cause mortality in patients with more intensive rehabilitation (P for trend <.05). However, no significant associations between rehabilitation frequency and pneumonia and hip fracture were identified in our study.
Intensive rehabilitation during the first year after stroke should be recommended to prevent detrimental adverse events for stroke survivors.
康复治疗对于所有中风后患者提高自我护理能力至关重要。然而，康复治疗频率增加是否能减少中风后不良事件仍未确定。
我们从数据库中选取了2000年1月1日至2008年12月31日期间新诊断的4899例缺血性中风患者，并根据查尔森合并症指数将他们分为3组，在中风后的第一年，他们又被进一步分为康复治疗频率不同的3组。采用Cox回归分析对包括复发性中风、髋部骨折、肺炎和全因死亡率在内的临床不良事件进行分析，以研究积极康复治疗的保护作用。
我们发现，尽管患者合并症严重程度不同，但中风后第一年的积极康复治疗与复发性中风和全因死亡率的较低发生率显著相关。进一步的Cox回归分析显示，康复治疗强度更大的患者发生复发性中风和全因死亡率的风险比降低（趋势P<.05）。然而，在我们的研究中，未发现康复治疗频率与肺炎和髋部骨折之间存在显著关联。
应建议在中风后的第一年进行强化康复治疗，以预防中风幸存者出现有害的不良事件。
