Satoshi Otokita, Hironori Uematsu, Susumu Kunisawa, Noriko Sasaki, Kiyohide Fushimi, Yuichi Imanaka
Graduate School of Medicine, Kyoto University, Department of Healthcare Economics and Quality Management, Kyoto, Japan.
DOI: 10.2340/16501977-2775

Objective: To investigate the optimum rehabilitation start timing for improved functional outcomes after stroke in Japan.
Design: A retrospective database study.
Subjects: 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.
Methods: 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.
Results: 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.
Conclusion: 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.

This study examined the effect on functional outcomes of the time after stroke of starting rehabilitation. A large national database was searched for eligible stroke patients, resulting in a total of 140,655 patients from 1,161 hospitals. Starting rehabilitation on the day of admission or second day of hospitalization after stroke was found to be associated with better functional outcomes at discharge than starting rehabilitation on the third day or later. For patients with haemorrhagic stroke, those who started rehabilitation on the second day of hospitalization had better functional outcome at discharge than those who started on the day of admission. Thus, starting rehabilitation on the day of admission or the second day of hospitalization after stroke may be the best timing for improved functional outcomes. However, among patients with haemorrhagic stroke, starting rehabilitation on the second day of hospitalization may result in better outcomes than starting on the day of admission.

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