Graduate School of Medicine, Kyoto University, Department of Healthcare Economics and Quality Management, Kyoto, Japan.
J Rehabil Med. 2021 Jan 13;53(1):jrm00145. doi: 10.2340/16501977-2775.
To investigate the optimum rehabilitation start timing for improved functional outcomes after stroke in Japan.
A retrospective database study.
A total of 140,655 patients with stroke from 1,161 acute hospitals in Japan. Only data for those patients who were discharged alive was included in the analysis.
Activities of daily living were assessed. Comparisons were made using the rehabilitation start day after hospital admission. Reference day 2 was compared with days 1, 3, 4, 5, and 6 or later. Modified Rankin Scale at time of discharge was used as the primary outcome. In addition, cases of ischaemic stroke and haemorrhagic stroke were analysed as separate subgroups.
Univariate and multivariate logistic regression analyses showed that starting rehabilitation on day 2 resulted in a better outcome than starting on day 3 or later. There was no significant difference in outcome between starting rehabilitation on days 1 and 2 in all cases and subgroup of patient with infarction stroke. For a subgroup of patients with haemorrhagic stroke, starting rehabilitation on day 2 resulted in a better outcome than starting on day 1.
Starting post-stroke rehabilitation on the day of admission or second day of hospitalization may be the optimum timing for functional outcomes. However, for haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may be more effective than on the day of admission.
探讨日本脑卒中患者改善功能预后的最佳康复起始时机。
回顾性数据库研究。
来自日本 1161 家急性医院的共 140655 例脑卒中患者。仅对存活出院的患者进行数据分析。
评估日常生活活动能力。将康复起始日与入院后天数进行比较。以第 2 天为参考日，与第 1、3、4、5 天及以后进行比较。采用出院时改良 Rankin 量表作为主要结局。此外，还对缺血性卒中和出血性卒中分亚组进行了分析。
单变量和多变量逻辑回归分析显示，第 2 天开始康复治疗的效果优于第 3 天或以后开始康复治疗。在所有病例和梗死性卒中亚组中，第 1 天和第 2 天开始康复治疗的结果无显著差异。对于出血性卒中亚组，第 2 天开始康复治疗的效果优于第 1 天。
脑卒中后在入院当天或第 2 天开始康复治疗可能是改善功能预后的最佳时机。但对于出血性卒中，在入院第 2 天开始康复治疗可能比入院当天更有效。
