Deans' stroke musings: Rehabilitation Provider Type Influences Functional Outcome and Survival of Acute Ischemic Stroke Patients With Severe Neurological Deficits: Findings From the China National Stroke Registry II

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, January 29, 2018

Rehabilitation Provider Type Influences Functional Outcome and Survival of Acute Ischemic Stroke Patients With Severe Neurological Deficits: Findings From the China National Stroke Registry II

Assuming your hospital has any competence at all this should immediately change their practices.
http://stroke.ahajournals.org/content/49/Suppl_1/ATMP43

Chelsea Liu, Liping Liu, Yuesong Pan, Xia Meng, Chunjuan Wang, Ying Xian, Qing Yang, Zixiao Li, Yongjun Wang, Janet P Bettger

2018;ATMP43

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.