Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Neijiang Street., Wanhua District, Taipei, 108, Taiwan.
Sci Rep. 2022 Jul 27;12(1):12811. doi: 10.1038/s41598-022-16984-9.
There is insufficient evidence to prove the effect of the Post-acute Care (PAC) program on post-stroke recovery. This study aimed to determine the effectiveness of the PAC versus traditional inpatient rehabilitation (non-PAC) for middle- and old-aged stroke survivors. This multicenter cohort study enrolled 334 stroke patients admitted for post-stroke rehabilitation. The outcome variables included the Barthel Index (BI), Functional Oral Intake Scale (FOIS), Mini Nutritional Assessment-Short Form (MNA-SF), EuroQoL-5D (EQ-5D), Lawton-Brody Instrumental Activities of Daily Living (ADL) Scale, and Mini-Mental State Examination (MMSE). The inverse-probability-of-treatment-weighting method was used to analyze the differences in outcomes between the PAC and non-PAC groups. The PAC group showed better improvements in BI, MNA-SF, EQ-5D, Instrumental ADL, and MMSE compared to the non-PAC group, with differences in effect sizes of 0.54 (95% confidence interval [CI] 0.38-0.71), 0.26 (95% CI 0.10-0.42), 0.50 (95% CI 0.33-0.66), 0.44 (95% CI 0.28-0.60) and 0.34 (95% CI 0.17-0.50), respectively. The PAC project showed more improvement in basic and instrumental ADL and status of swallowing, nutrition, and cognition than those of non-PAC, which had less length of stay restricted by the National Health Insurance. More studies are warranted to investigate the influence of hospital stay and duration from stroke onset on the PAC's effectiveness.
没有足够的证据证明急性后期护理（PAC）方案对脑卒中后恢复的影响。本研究旨在确定 PAC 与传统住院康复（非-PAC）对中老年人脑卒中幸存者的效果。这项多中心队列研究纳入了 334 名因脑卒中后康复而住院的患者。主要结局变量包括巴氏指数（BI）、功能性口腔摄入量表（FOIS）、微型营养评定-简表（MNA-SF）、欧洲五维健康量表（EQ-5D）、洛温-布罗迪日常生活活动量表（Lawton-Brody Instrumental ADL Scale）和简易精神状态检查（MMSE）。采用逆概率处理加权法分析 PAC 与非-PAC 组之间结局的差异。与非-PAC 组相比，PAC 组 BI、MNA-SF、EQ-5D、工具性日常生活活动和 MMSE 改善更明显，效应量差异分别为 0.54（95%置信区间 0.38-0.71）、0.26（95%置信区间 0.10-0.42）、0.50（95%置信区间 0.33-0.66）、0.44（95%置信区间 0.28-0.60）和 0.34（95%置信区间 0.17-0.50）。PAC 项目在基本和工具性日常生活活动以及吞咽、营养和认知状况方面的改善程度均优于非-PAC 项目，非-PAC 项目的住院时间因受国民健康保险的限制而较短。需要更多的研究来探讨住院时间和脑卒中发病到治疗的时间对 PAC 效果的影响。
