Rehabilitation of Patients With Acute Ischemic Stroke Who Required Assistance Before Hospitalization Contributes to Improvement in Activities of Daily Living: A Nationwide Database Cohort Study

Objective: To assess the effect of early implementation of and longer daily duration of rehabilitation on patients with acute ischemic stroke who require assistance with activities of daily living (ADL) before hospital admission. Design: Nationwide, cohort, observational study from April 2018 to March 2019. Setting: Acute care hospitals in Japan. Participants: The Japanese national Diagnosis Procedure Combination database was searched for the period between April 2018 and March 2019. Of the 330,672 patients with ischemic strokes identified, 53,523 met the inclusion criteria of being older than 20 years, having a prehospital modified Rankin Scale score of 3, 4, or 5, and having undergone rehabilitation (N=53,523). Interventions: Not applicable. Main Outcome Measures: Improvement in ADL from admission to discharge using the Barthel Index. The effects of the following 3 rehabilitation variables on ADL improvement were evaluated: (1) average daily duration of rehabilitation; (2) rehabilitation started within 3 days after admission (early rehabilitation); and (3) rehabilitation started 1 day after admission (very early rehabilitation). Results: Early rehabilitation was significantly associated with improvements in ADL (odds ratio, 1.19; 95% confidence interval, 1.10-1.28; P≤.001). A longer duration of rehabilitation was also significantly associated with ADL improvement (≥2.0 hours: odds ratio, 2.49; 95% confidence interval, 2.26-2.75; P≤.001) compared with a ≤1 hour of rehabilitation (1.1-2.0 hours: odds ratio, 1.35; 95% confidence interval, 1.29-1.42; P≤.001). Conclusions: Early implementation of rehabilitation and a longer duration of rehabilitation per day improved the ADL of patients who required assistance before the onset of cerebral infarction.