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.

Ying-Chu Chen,Yu-Cih Yang,Hei-Tung Yip,Hung-Yu Cheng,Tai-Li Chen,Chia-Chun Cheng,Chung-Yi Hsu,Jen-Hung Wang

doi:10.3390/medicina58030402

Abstract

Background and Objectives: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Highlights

Pressure ulcers (PU) are a worldwide health problem occurring in 50% of critically ill patients and in more than 70% of elderly patients in nursing homes in the United States [1]; it occurs commonly in stroke patients, diminishing their quality of life and significantly increasing morbidity and mortality [2,3]
The rehabilitation group consisted of 9829 patients, while the comparison cohort consisted of 9142 patients
The dominant characteristics were: male patients, age more than 65 years, National Institutes of Health Stroke Scale (NIHSS) score less than 13, urbanization level 4, and patients living in the northern region

Summary

Introduction

Pressure ulcers (PU) are a worldwide health problem occurring in 50% of critically ill patients and in more than 70% of elderly patients in nursing homes in the United States [1]; it occurs commonly in stroke patients, diminishing their quality of life and significantly increasing morbidity and mortality [2,3]. It is estimated that 65,000 out of every 1 million patients who develop PUs die from complications; this presents a major health problem worldwide [6]. Stroke remains a leading cause of mortality and disability worldwide [7], with an estimated 16 million people affected annually [8]. Post-stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patients striving for their goals, family and friends, major caregivers, physicians, nurses, physical, occupational, speech, and recreational therapists, psychologists, nutritionists, social workers, and others [9]. Immobilityrelated complications are common among stroke survivors in the first year after a severely disabling stroke [10], with half of them unable to return to work because of post-stroke disabilities [11,12]

Methods

Results

Discussion

Conclusion