Tohoku J. Exp. Med., 2020 September, 252 (1)

Shorter Interval between Onset and Admission to Convalescent Rehabilitation Wards Is Associated with Improved Outcomes in Ischemic Stroke Patients

YOSHIHIRO YOSHIMURA,¹ HIDETAKA WAKABAYASHI,² RYO MOMOSAKI,³ FUMIHIKO NAGANO,¹ SAYURI SHIMAZU¹ and AI SHIRAISHI¹

¹Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kikuchi-gun, Kumamoto, Japan
²Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
³Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan

As Japan's population ages, there is a growing interest in regional health care coordination. Our study aimed to evaluate whether the interval between onset and admission to convalescent rehabilitation wards (onset-admission) was associated with outcomes in ischemic stroke patients. We conducted a retrospective cohort study in a single rehabilitation hospital. Ischemic stroke patients consecutively admitted to the wards were eligible to enroll. Outcomes included Functional Independence Measure (FIM)-motor gain, the Food Intake Level Scale (FILS) and a discharge rate to home. FIM assesses functional independence, including motor (FIM-motor) and cognitive domains, and is a measure of activities of daily living (ADLs). The FIM-motor gain indicates the difference between the FIM-motor scores at admission and discharge. FILS is a 10-point observer-rated scale to measure swallowing. After enrollment, 481 patients (mean age 74.4 years; 45.7% women) were included. The median [interquartile range] onset-admission interval was 13 [10-20] days and the median National Institute of Health Stroke Scale score, a measure of stroke severity, was 8 [3-13]. In multivariate analysis, the onset-admission interval was independently associated with FIM-motor gain (β = −0.107, p = 0.024), FILS score at discharge (β = −0.159, p = 0.041), and the rate of discharge to home (odds ratio: 0.946, p = 0.032). In conclusion, a shorter interval between stroke onset and admission to convalescent rehabilitation wards contributes to improved outcomes, including ADLs, dysphagia, and a discharge rate to home, in ischemic stroke patients, regardless of stroke severity.

Keywords —— activities of daily living; community-based integrated care system; dysphagia; early rehabilitation; home discharge

© 2020 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2020 , 252, 15-22.

Correspondence: Yoshihiro Yoshimura, Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-machi, Kikuchi-gun, Kumamoto 869-1106, Japan.

e-mail: hanley.belfus@gmail.com