Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission

This is so easy to figure out. If a stroke patient can do high intensity therapy that obviously would mean that they probably had much less damage to begin with. This is where we absolutely need an objective diagnosis in 3d of the dead and damaged areas. With that we wouldn't be making such stupid  mistakes. Whom from the ASA/NSA is going to contact these researchers?
http://ptjournal.apta.org/content/early/2015/06/11/ptj.20140610.abstract

1. A. Williams Andrews (andrewsb@elon.edu),

1. Dongmei Li and

1. Janet K. Freburger

+ Author Affiliations

1. A.W. Andrews, PT, EdD, NCS, Department of Physical Therapy Education, Elon University, Campus Box 2085, Elon, NC 27244 (USA).
2. D. Li, MS, The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
3. J.K. Freburger, PT, PhD, The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.

Abstract

Background Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions.

Objective The objective of our study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission.

Design A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida.

Methods 64,065 patients who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium low, medium high, or high based on the sum and distribution of physical, occupational, and speech therapy charges within each hospital. We used Cox proportional hazards regression to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state.

Results Relative to patients who received the lowest intensity therapy, those who received higher intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest intensity group [HR: 0.86 (0.79-0.93)]. We also found that individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low intensity therapy [HR: 1.30 (1.22-1.40)]. Our findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher intensity therapy had more comorbidities and greater illness severity relative to those who received lower intensity rehabilitation.

Limitations Our results are limited in scope and generalizability. Also, we may not have adequately accounted for all potentially important covariates.(Yes, you missed the most important one - severity)                     

Conclusions Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission. (Right conclusion, wrong reason)