Abstract
BackgroundRehabilitation can improve physical activity after stroke. However, patients may be more prone to falls and fractures because of balance and gait deficits. Few reports have studied the relationship between rehabilitation and subsequent fractures after ischemic stroke.ObjectiveTo investigate whether post-stroke rehabilitation affects fracture risk.MethodsWe conducted a population-based retrospective cohort study based on the Taiwan National Health Insurance Research Database. Patients with a newly diagnosed ischemic stroke between 2000 and 2012 were included. After propensity score matching, a total of 8,384 patients were enrolled. Half of the patients (4,192) received post-stroke rehabilitation within 1 month; the other half did not receive any post-stroke rehabilitation. Cox proportional hazards regression model was used to calculate hazard ratios (HRs) for fractures among patients with and without rehabilitation within 1 year after ischemic stroke. Patients were further stratified by sex and age (20–64 and ≥65 years).ResultsPatients receiving post-stroke rehabilitation had a higher incidence of fracture (6.2 per 100 person-years) than those who did not (4.1 per 100 person-years) after adjustment for sociodemographic and coexisting medical conditions [HR = 1.53, 95% confidence interval (CI) = 1.25–1.87, p < 0.001]. The analyses performed after stratifying for sex and age showed that only older women undergoing rehabilitation had a significantly higher risk of fracture (HR = 1.62, 95% CI = 1.21–2.17, p = 0.001).ConclusionRehabilitation after ischemic stroke is associated with an increased fracture risk in older women.
Highlights
Ischemic stroke is a devastating disease, resulting in disability in nearly half of the patients at hospital discharge [1]
Patients receiving post-stroke rehabilitation had a higher incidence of fracture (6.2 per 100 person-years) than those who did not (4.1 per 100 person-years) after adjustment for sociodemographic and coexisting medical conditions [hazard ratios (HRs) = 1.53, 95% confidence interval (CI) = 1.25–1.87, p < 0.001]
The analyses performed after stratifying for sex and age showed that only older women undergoing rehabilitation had a significantly higher risk of fracture (HR = 1.62, 95% CI = 1.21–2.17, p = 0.001)
Summary
Ischemic stroke is a devastating disease, resulting in disability in nearly half of the patients at hospital discharge [1]. It is a major risk factor for hip fracture regardless of age or sex. It has been reported that stroke is associated with a two-fold increase in the risk of hip or femur fracture [2]. Inability to maintain balance impairs functional performance and results in a higher frequency of falls [6]. Few reports have studied the relationship between rehabilitation and subsequent fractures after ischemic stroke
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