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Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

BACKGROUND: While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe strok...

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Autores principales: Reuter, Björn, Gumbinger, Christoph, Sauer, Tamara, Wiethölter, Horst, Bruder, Ingo, Diehm, Curt, Ringleb, Peter A., Hacke, Werner, Hennerici, Michael G., Kern, Rolf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112693/
https://www.ncbi.nlm.nih.gov/pubmed/27852229
http://dx.doi.org/10.1186/s12883-016-0744-7
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author Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Hacke, Werner
Hennerici, Michael G.
Kern, Rolf
author_facet Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Hacke, Werner
Hennerici, Michael G.
Kern, Rolf
author_sort Reuter, Björn
collection PubMed
description BACKGROUND: While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice. METHODS: 99,753 IS patients and 8824 patients with ICH hospitalized from January 2008 to December 2012 were analyzed. Data on the access to physical therapy (PT), occupational therapy (OT), and speech therapy (ST), the time from admission to first contact with a therapist and the average number of therapy sessions during the first 7 days of admission are reported. Multiple logistic regression models adjusted for patient and treatment characteristics were carried out to investigate the influence of VER on clinical outcome. RESULTS: PT was applied in 90/87% (IS/ICH), OT in 63/57%, and ST in 70/65% of the study population. Therapy was mostly initiated within 24 h (PT 87/82%) or 48 h after admission (OT 91/89% and ST 93/90%). Percentages of patients under therapy and also the average number of therapy sessions were highest in those with a discharge modified Rankin Scale score of 2 to 5 and lowest in patients with complete recovery or death during hospitalization. The outcome analyses were fundamentally hindered due to biases by individual decision making regarding the application and frequency of VER. CONCLUSIONS: While most patients had access to PT we noticed an undersupply of OT and ST. Only little differences were observed between patients with IS and ICH. The staff decisions for treatment seem to reflect attempts to optimize resources. Patients with either excellent or very unfavorable prognosis were less frequently assigned to VER and, if treated, received a lower average number of therapy sessions. On the contrary, severely disabled patients received VER at high frequency, although potentially harmful according to recent indications from the randomized controlled AVERT trial.
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spelling pubmed-51126932016-11-23 Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry Reuter, Björn Gumbinger, Christoph Sauer, Tamara Wiethölter, Horst Bruder, Ingo Diehm, Curt Ringleb, Peter A. Hacke, Werner Hennerici, Michael G. Kern, Rolf BMC Neurol Research Article BACKGROUND: While the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice. METHODS: 99,753 IS patients and 8824 patients with ICH hospitalized from January 2008 to December 2012 were analyzed. Data on the access to physical therapy (PT), occupational therapy (OT), and speech therapy (ST), the time from admission to first contact with a therapist and the average number of therapy sessions during the first 7 days of admission are reported. Multiple logistic regression models adjusted for patient and treatment characteristics were carried out to investigate the influence of VER on clinical outcome. RESULTS: PT was applied in 90/87% (IS/ICH), OT in 63/57%, and ST in 70/65% of the study population. Therapy was mostly initiated within 24 h (PT 87/82%) or 48 h after admission (OT 91/89% and ST 93/90%). Percentages of patients under therapy and also the average number of therapy sessions were highest in those with a discharge modified Rankin Scale score of 2 to 5 and lowest in patients with complete recovery or death during hospitalization. The outcome analyses were fundamentally hindered due to biases by individual decision making regarding the application and frequency of VER. CONCLUSIONS: While most patients had access to PT we noticed an undersupply of OT and ST. Only little differences were observed between patients with IS and ICH. The staff decisions for treatment seem to reflect attempts to optimize resources. Patients with either excellent or very unfavorable prognosis were less frequently assigned to VER and, if treated, received a lower average number of therapy sessions. On the contrary, severely disabled patients received VER at high frequency, although potentially harmful according to recent indications from the randomized controlled AVERT trial. BioMed Central 2016-11-16 /pmc/articles/PMC5112693/ /pubmed/27852229 http://dx.doi.org/10.1186/s12883-016-0744-7 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Reuter, Björn
Gumbinger, Christoph
Sauer, Tamara
Wiethölter, Horst
Bruder, Ingo
Diehm, Curt
Ringleb, Peter A.
Hacke, Werner
Hennerici, Michael G.
Kern, Rolf
Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title_full Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title_fullStr Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title_full_unstemmed Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title_short Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry
title_sort access, timing and frequency of very early stroke rehabilitation – insights from the baden-wuerttemberg stroke registry
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112693/
https://www.ncbi.nlm.nih.gov/pubmed/27852229
http://dx.doi.org/10.1186/s12883-016-0744-7
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