This study aimed to assess the effects of increased rehabilitation doses on the recovery of transfer and mobility activities among inpatients with ischemic stroke who required assistance before hospitalization.
This observational study was conducted using a hospital database and included stroke patients hospitalized between April 1, 2020, and March 31, 2022. All participants had a pre-hospitalization modified Rankin Scale (mRS) score of 4 or 5. Rehabilitation doses were categorized into five groups: ≤ 40 minutes, 40-60 minutes, 60-80 minutes, 80-120 minutes, and ≥ 120 minutes per day. The primary outcome was the improvement of sedentary activities, evaluated using the Barthel Index. A generalized linear model with a log-link function and quasi-Poisson distribution was used to estimate the effectiveness of daily rehabilitation doses on sedentary activities, with inverse probability of treatment weighting (IPTW) applied.
Among 17,733 patients, longer rehabilitation durations were significantly associated with improvements in maintaining a seated position, transferring, and self-propelling in a wheelchair. Patients receiving 40-60 minutes of rehabilitation per day demonstrated a 6% improvement in sitting ability (estimate 1.06, CI 1.00-1.12, p=0.042). Patients receiving ≥ 120 minutes of rehabilitation showed a 67% improvement (estimate 1.67, CI 1.59-1.76, p0.001). Similarly, transfer skills improved by 33% in the 60–80-minute group (estimate 1.33, CI 1.25-1.43, p0.001) and by 68% in the ≥ 120-minute group (estimate 1.68, CI 1.58-1.79, p0.001). Significant improvements were also observed in the ability to transfer independently and self-propel in a wheelchair, particularly in the ≥ 120-minute group (transfer independently: estimate 1.45, p0.001; self-propel in a wheelchair: estimate 1.56, p0.001).
Increased rehabilitation doses were associated with significant improvements in sitting, transferring, and self-propelling activities. Patients who received higher doses of daily rehabilitation demonstrated better outcomes in sedentary activities.
Increasing the daily rehabilitation dose improves the ability of stroke patients who require assistance before hospitalization to perform transfer and mobility activities. Even for patients who may not fully recover their ability to perform ADL, providing sufficient rehabilitation may enhance their functional independence and reduce the burden on families and caregivers.
ADL
hospital care
