Clinical Management Provided by Board-Certificated Physiatrists in Early Rehabilitation Is a Significant Determinant of Functional Improvement in Acute Stroke Patients: A Retrospective Analysis of Japan Rehabilitation Database

This is just so f*cking self-servingly wrong. They are incredibly incompetent if this is their conclusion.  All recovery in the early weeks is spontaneous, having NOTHING to do with the attending physician. Just because someone is standing next to Michael Jordan as he makes a basket is no reason to attribute any of that to you standing next to him. And these people have MD and doctorates behind their names.
http://www.sciencedirect.com/science/article/pii/S1052305714006399

• Shoji Kinoshita, MD,
• Wataru Kakuda, MD, PhD,
• Ryo Momosaki, MD, PhD,
• Naoki Yamada, MD,
• Hidekazu Sugawara, MD, PhD,
• Shu Watanabe, MD, PhD,
• Masahiro Abo, MD, PhD^,

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Background

Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties.

Methods

Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination.

Results

After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005).

Conclusions

Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke.