|発表テーマ||Impact of early admission to inpatient rehabilitation facilities on functional outcome in patients with stroke: An instrumental variable analysis|
|発表学会名||The International Stroke Conference 2019|
|主催者||American Heart Association|
|概要||Objective: This study aimed to determine whether early admission of stroke patients into an inpatient rehabilitation facility (IRF) resulted in improvement in motor function during hospitalization. Methods: Data were extracted from the Japan association of rehabilitation database for 2,760 patients admitted to IRFs at 28 centers. Early IRF admission was defined as that 14days from onset to IRF admission. Items surveyed were age; sex; stroke type; length of stay; period from onset to IRF admission; motor functional independence measure (mFIM) and cognitive FIM at admission and discharge; and modified Rankin Scale before onset, at admission, and at discharge. In addition, the difference between mFIM at admission and at discharge per day(ΔmFIM/day) was calculated dividing by the length of stay. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. We defined intensive rehabilitation as rehabilitation conducted at first quartile (>6.8 unit/day). A multiple regression analysis and instrumental variable analysis were performed to examine the association of early rehabilitation with ADL at discharge.
Results: ΔmFIM/day was higher in early rehabilitation and intensive rehabilitation. The multiple regression analysis showed that significant improvements in ΔmFIM/day were observed for intensive rehabilitation(partial regression coefficient:1.56; 95% confidence interval: 0.34-2.8) controlling for a variety of confounding variables. The instrumental variable analysis showed that ΔmFIM/day was associated with Early IRF admission(partial regression coefficient: 0.1; 95% confidence interval:0.05-0.14).
Conclusion: Stroke patients experience greater improvement in ADL, if admitted to an IRF within 14 days after stroke onset.