High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study
<i>Background and Objectives:</i> Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. <i>M...
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| Format: | Article |
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MDPI AG
2022-03-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/3/402 |
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| author | Ying-Chu Chen Tai-Li Chen Chia-Chun Cheng Yu-Cih Yang Jen-Hung Wang Hei-Tung Yip Chung-Yi Hsu Hung-Yu Cheng |
| author_facet | Ying-Chu Chen Tai-Li Chen Chia-Chun Cheng Yu-Cih Yang Jen-Hung Wang Hei-Tung Yip Chung-Yi Hsu Hung-Yu Cheng |
| author_sort | Ying-Chu Chen |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. <i>Materials and Methods:</i> Data of patients diagnosed with stroke between 2000 and 2012 were collected from the 2000 Longitudinal Health Insurance Database (Taiwan). Based on the number of rehabilitation sessions attended within 90 days of discharge, the rehabilitation intensity was classified as low, medium, or high. After adjusting for sociodemographic factors and comorbidities, the Cox proportional hazards model evaluated the risk of PU development during the 12-year follow-up period. Kaplan–Meier curves were used to estimate the cumulative incidence of PUs. <i>Results:</i> Our study included 18,971 patients who had their first episode of stroke. Of these, 9829 (51.8%) underwent rehabilitation therapy after discharge. Female patients and patients with a National Institutes of Health Stroke Scale (NIHSS) score >13 points, who commenced high-intensity post-stroke rehabilitation after discharge had a significantly lower risk of PU development than those who underwent low-intensity post-stroke rehabilitation after discharge. Cumulative survival analysis showed a significantly lower cumulative incidence of PU during the 12-year follow-up period in the high-intensity rehabilitation group. <i>Conclusion:</i> Compared with low-intensity post-stroke rehabilitation, high-intensity post-stroke rehabilitation after discharge from hospital is associated with a lower risk of post-stroke PU development, especially in female stroke patients and patients with a NIHSS score >13 points. High-intensity rehabilitation is also associated with a significantly lower cumulative incidence of PU events during the 12-year follow-up period. |
| first_indexed | 2024-03-09T13:24:09Z |
| format | Article |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T13:24:09Z |
| publishDate | 2022-03-01 |
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| series | Medicina |
| spelling | doaj.art-3c5ccffa3671408eb6bc95c84a7c2f042023-11-30T21:26:29ZengMDPI AGMedicina1010-660X1648-91442022-03-0158340210.3390/medicina58030402High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort StudyYing-Chu Chen0Tai-Li Chen1Chia-Chun Cheng2Yu-Cih Yang3Jen-Hung Wang4Hei-Tung Yip5Chung-Yi Hsu6Hung-Yu Cheng7Buddhist Tzu Chi Medical Foundation, Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, TaiwanBuddhist Tzu Chi Medical Foundation, Center for Aging and Health, Hualien Tzu Chi Hospital, Hualien 970, TaiwanBuddhist Tzu Chi Medical Foundation, Department of Pathology, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, TaiwanManagement Office for Health Data, China Medical University Hospital, Taichung 404, TaiwanBuddhist Tzu Chi Medical Foundation, Department of Medical Research, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, TaiwanManagement Office for Health Data, China Medical University Hospital, Taichung 404, TaiwanGraduate Institute of Clinical Medical Science, China Medical University, Taichung 404, TaiwanBuddhist Tzu Chi Medical Foundation, Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, Taiwan<i>Background and Objectives:</i> Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. <i>Materials and Methods:</i> Data of patients diagnosed with stroke between 2000 and 2012 were collected from the 2000 Longitudinal Health Insurance Database (Taiwan). Based on the number of rehabilitation sessions attended within 90 days of discharge, the rehabilitation intensity was classified as low, medium, or high. After adjusting for sociodemographic factors and comorbidities, the Cox proportional hazards model evaluated the risk of PU development during the 12-year follow-up period. Kaplan–Meier curves were used to estimate the cumulative incidence of PUs. <i>Results:</i> Our study included 18,971 patients who had their first episode of stroke. Of these, 9829 (51.8%) underwent rehabilitation therapy after discharge. Female patients and patients with a National Institutes of Health Stroke Scale (NIHSS) score >13 points, who commenced high-intensity post-stroke rehabilitation after discharge had a significantly lower risk of PU development than those who underwent low-intensity post-stroke rehabilitation after discharge. Cumulative survival analysis showed a significantly lower cumulative incidence of PU during the 12-year follow-up period in the high-intensity rehabilitation group. <i>Conclusion:</i> Compared with low-intensity post-stroke rehabilitation, high-intensity post-stroke rehabilitation after discharge from hospital is associated with a lower risk of post-stroke PU development, especially in female stroke patients and patients with a NIHSS score >13 points. High-intensity rehabilitation is also associated with a significantly lower cumulative incidence of PU events during the 12-year follow-up period.https://www.mdpi.com/1648-9144/58/3/402pressure ulcerspressure injuriesstrokerehabilitation |
| spellingShingle | Ying-Chu Chen Tai-Li Chen Chia-Chun Cheng Yu-Cih Yang Jen-Hung Wang Hei-Tung Yip Chung-Yi Hsu Hung-Yu Cheng High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study Medicina pressure ulcers pressure injuries stroke rehabilitation |
| title | High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study |
| title_full | High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study |
| title_fullStr | High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study |
| title_full_unstemmed | High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study |
| title_short | High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study |
| title_sort | high intensity post stroke rehabilitation is associated with lower risk of pressure ulcer development in patients with stroke real world evidence from a nationwide population based cohort study |
| topic | pressure ulcers pressure injuries stroke rehabilitation |
| url | https://www.mdpi.com/1648-9144/58/3/402 |
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