Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score
Abstract
:1. Introduction
- Is a multidisciplinary PAC program delivered early after stroke effective in restoring function?
- Should intensive rehabilitative PAC for stroke routinely include interventions for overall improvement of functional status?
2. Materials and Methods
2.1. The PAC Program
2.2. Sample and Study Design
2.3. Instruments and Measurements
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions and Implications
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Before Propensity Score Matching | After Propensity Score Matching | ||||||
---|---|---|---|---|---|---|---|
Variables | PAC Group (n = 942) | Non-PAC Group (n = 587) | p Value | PAC Group (n = 273) | Non-PAC Group (n = 273) | p Value | |
Age, years | 69.3 ± 8.5 | 68.8 ± 7.6 | 0.736 | 69.1 ± 8.3 | 68.9 ± 8.0 | 0.834 | |
Gender | Female | 403 (42.8%) | 238 (40.6%) | 0.704 | 116 (42.4%) | 114 (41.9%) | 0.684 |
Male | 539 (57.2%) | 349 (59.4%) | 157 (57.6%) | 159 (58.1%) | |||
Education, years | 7.8 ± 4.3 | 9.4 ± 4.5 | <0.001 | 8.9 ± 4.1 | 9.2 ± 4.4 | 0.888 | |
BMI, kg/m2 | 24.4 ± 3.2 | 24.4 ± 3.9 | 0.976 | 24.0 ± 3.0 | 23.9 ± 3.3 | 0.849 | |
Stroke type | Ischemic | 806 (85.6%) | 512 (87.2%) | 0.669 | 232(85.0%) | 236 (86.4%) | 0.891 |
Hemorrhagic | 136 (14.4%) | 75 (12.8%) | 41 (15.0%) | 37 (13.6%) | |||
Hypertension | Yes | 677 (71.9%) | 421 (71.8%) | 0.995 | 196 (72.0%) | 196 (72.0%) | 0.997 |
Hyperlipidemia | Yes | 265 (28.1%) | 273 (46.5%) | <0.001 | 114 (41.8%) | 117 (42.8%) | 0.507 |
Diabetes mellitus | Yes | 343 (36.4%) | 338 (57.6%) | 0.270 | 103 (37.7%) | 102 (37.4%) | 0.990 |
Atrial fibrillation | Yes | 78 (8.3%) | 49 (8.3%) | 0.989 | 22(8.0%) | 17 (6.3%) | 0.534 |
Previous stroke | Yes | 131 (13.9%) | 146 (24.9%) | <0.001 | 49 (18.0%) | 50 (18.4%) | 0.879 |
Acute care LOS, days | 13.01 ± 27.83 | 24.45 ± 34.61 | <0.001 | 23.75 ± 11.84 | 24.50 ± 11.56 | 0.356 | |
LOS during rehabilitation, days | 31.52 ± 17.75 | 37.1 ± 12.59 | <0.001 | 35.52 ± 12.04 | 36.63 ± 11.91 | 0.916 | |
BI score before rehabilitation | 41.91 ± 23.10 | 34.67 ± 23.48 | <0.001 | 34.90 ± 20.00 | 34.43 ± 17.80 | 0.879 | |
FOIS score before rehabilitation | 5.95 ± 3.04 | 5.38 ± 2.25 | <0.001 | 5.57 ± 2.80 | 5.13 ± 2.75 | 0.974 | |
EQ5D score before rehabilitation | 10.67 ± 1.86 | 10.40 ±1.78 | 0.015 | 10.81 ± 1.90 | 10.87 ± 2.15 | 0.891 | |
IADL score before rehabilitation | 1.41 ± 1.20 | 1.15 ± 1.12 | <0.001 | 1.32 ± 1.14 | 1.13 ± 1.01 | 0.934 | |
BBS score before rehabilitation | 15.30 ± 14.99 | 16.91 ± 17.27 | 0.097 | 16.13 ± 14.08 | 16.67 ± 15.57 | 0.882 | |
MMSE score before rehabilitation | 20.15 ± 7.90 | 18.50 ± 9.66 | 0.001 | 20.67 ± 11.50 | 19.57 ± 10.20 | 0.859 |
Functional Status Measures | Before Rehabilitation | After Rehabilitation | 12th Week after Rehabilitation before Rehabilitation | 1st Year after Rehabilitation before Rehabilitation | ||||
---|---|---|---|---|---|---|---|---|
12th Week | 1st Year | |||||||
Mean | Mean | Mean | Mean | Standard Error | Mean | Standard Error | ||
BI | PAC | 51.90 | 59.32 | 65.76 | 7.42 | 1.95 | 13.86 | 4.84 |
Non-PAC | 50.79 | 54.20 | 60.29 | 3.41 | 1.18 | 9.50 | 3.66 | |
Difference | 1.12 | 3.12 | 3.47 | 4.01 | 0.88 | 4.36 | 0.91 | |
FOIS | PAC | 5.38 | 6.39 | 6.52 | 1.01 | 0.12 | 1.14 | 0.19 |
Non-PAC | 5.19 | 5.74 | 5.95 | 0.55 | 0.11 | 0.76 | 0.15 | |
Difference | 0.19 | 0.65 | 0.58 | 0.46 | 0.10 | 0.38 | 0.07 | |
EQ-5D | PAC | 8.41 | 6.28 | 4.99 | −2.13 | 0.43 | −3.42 | 0.58 |
Non-PAC | 8.92 | 8.12 | 7.53 | −0.80 | 0.42 | −1.39 | 0.41 | |
Difference | −0.50 | −1.84 | −2.54 | −1.33 | 0.16 | −2.03 | −0.26 | |
IADL | PAC | 1.58 | 2.85 | 3.42 | 1.27 | 0.11 | 1.84 | 0.12 |
Non-PAC | 1.17 | 2.36 | 2.90 | 1.19 | 0.18 | 1.73 | 0.20 | |
Difference | 0.40 | 0.50 | 0.52 | 0.08 | 0.03 | 0.11 | 0.03 | |
BBS | PAC | 20.59 | 29.53 | 34.40 | 8.94 | 1.32 | 13.81 | 4.25 |
Non-PAC | 18.89 | 24.85 | 29.60 | 5.96 | 1.64 | 10.71 | 2.38 | |
Difference | 1.70 | 4.68 | 4.80 | 2.98 | 0.68 | 3.10 | 0.83 | |
MMSE | PAC | 20.72 | 22.46 | 23.13 | 1.74 | 0.20 | 2.41 | 0.22 |
Non-PAC | 19.41 | 20.77 | 21.15 | 1.36 | 0.18 | 1.74 | 0.13 | |
Difference | 1.31 | 1.69 | 1.98 | 0.38 | 0.10 | 0.67 | 0.10 |
Variables | BI | FOIS | EQ-5D | IADL | BBS | MMSE |
---|---|---|---|---|---|---|
Group PAC vs. non-PAC | 2.24 * | 0.46 * | −0.47 ** | 0.15 ** | 1.94 * | 0.27 * |
Gender Male vs. female | 0.01 | 0.02 | −0.02 | 0.15 | 0.76 | 0.07 |
Age, years | −0.20 ** | −0.02 | 0.02 *** | −0.01 ** | −0.17 *** | −0.07 ** |
Education, years | 0.12 | 0.01 | 0.04 | 0.01 | −0.13 | 0.02 |
BMI, kg/m2 | 0.23 | 0.01 | 0.01 | 0.02 | 0.07 | 0.07 |
Stroke type Ischemic vs. hemorrhagic | 0.14 | 0.15 | −0.43 * | 0.23 * | −0.08 | −0.18 |
CCI, score | 1.78 | −0.01 | −0.03 | −0.19 | 1.42 | −0.33 |
Length of stay, days | 0.04 | −0.01 | 0.01 | −0.01 | 0.02 | 0.01 |
UTI Yes vs. no | −1.56 | −0.04 | 0.30 | 0.02 | −0.86 | 1.11 |
Renal disease Yes vs. no | 0.41 | 0.06 | 0.18 | 0.01 | −1.27 | 0.24 |
Hypertension Yes vs. no | −2.26 | 0.03 | −0.05 | 0.04 | −1.67 | 0.07 |
Diabetes Yes vs. no | −0.18 | 0.05 | 0.14 | 0.23 | −0.33 | 0.64 |
Hyperlipidemia Yes vs. no | 1.80 | 0.13 | −0.11 | 0.09 | 0.29 | −0.06 |
Functional status before rehabilitation | 0.82 *** | 0.69 *** | −0.74 *** | 0.86 *** | 0.83 *** | 0.73 *** |
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Chiu, C.-C.; Lin, H.-F.; Lin, C.-H.; Chang, H.-T.; Hsien, H.-H.; Hung, K.-W.; Tung, S.-L.; Shi, H.-Y. Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score. Int. J. Environ. Res. Public Health 2021, 18, 7696. https://doi.org/10.3390/ijerph18147696
Chiu C-C, Lin H-F, Lin C-H, Chang H-T, Hsien H-H, Hung K-W, Tung S-L, Shi H-Y. Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score. International Journal of Environmental Research and Public Health. 2021; 18(14):7696. https://doi.org/10.3390/ijerph18147696
Chicago/Turabian StyleChiu, Chong-Chi, Hsiu-Fen Lin, Ching-Huang Lin, Hong-Tai Chang, Hong-Hsi Hsien, Kuo-Wei Hung, Sheng-Li Tung, and Hon-Yi Shi. 2021. "Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score" International Journal of Environmental Research and Public Health 18, no. 14: 7696. https://doi.org/10.3390/ijerph18147696
APA StyleChiu, C. -C., Lin, H. -F., Lin, C. -H., Chang, H. -T., Hsien, H. -H., Hung, K. -W., Tung, S. -L., & Shi, H. -Y. (2021). Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score. International Journal of Environmental Research and Public Health, 18(14), 7696. https://doi.org/10.3390/ijerph18147696