In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
Abstract:
Background: Task-shifting rehabilitative care from rehabilitation therapists to physicians, nurses, and relatives may supplement the shortage of specialized rehabilitation personnel in China. However, it is unknown how this practice affects patient outcomes. This study examined the association of rehabilitation provider type with functional dependence and mortality among patients with acute ischemic stroke (AIS) in China. Methods: Patients with AIS hospitalized at participating China National Stroke Registry II hospitals were eligible if they had no pre-stroke disability (modified Rankin Scale [mRS]=0-2), had moderate to severe neurological deficits at admission (NIHSS 〉 4), and returned home after hospital discharge. Using multivariable logistic and Cox regression models, we compared rehabilitation care provided by therapists versus physicians, nurses, or relatives on functional dependence (mRS=3-6) and mortality at 3, 6, and 12 months after discharge, adjusting for patient characteristics. Results: A total of 3741 patients received in-hospital rehabilitation, 56.21% from rehabilitation therapists and 43.79% from others. Among patients with NIHSS=5-9 and NIHSS=10-14, there were no differences between groups for any of the outcomes (Table 1). However, for severe stroke patients (NIHSS 〉 14), non-therapist care was associated with higher odds of mortality at 3-months follow-up (HR=2.13, 95%CI 1.11-4.07, P=0.02) and 12-months follow-up (HR=1.88, 95%CI 1.17-3.01, P=0.01). Hospital-level analysis showed that it was more common for nonteaching hospitals to be without rehabilitation therapists. Conclusions: This study suggests a lower mortality risk for patients with severe stroke when treated by a rehabilitation therapist versus others. Future studies should explore the dose, frequency and focus of acute stroke rehabilitation by different providers to better delineate the mechanisms for improving patient outcomes.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.49.suppl_1.TMP43
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
1467823-8
