The effects of a self-exercise program on ADL in acute patients following stroke - a propensity score analysis based on the Japan Association of Rehabilitation Database (JARD)

Publication date: Available online 12 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Nariaki Shiraishi, Yusuke Suzuki, Daisuke Matsumoto, Seungwon Jeong, Motoya Sugiyama, Katsunori Kondo
ObjectiveTo investigate whether self-exercise programs (SEPs) for patients following stroke contribute to improved activities of daily living (ADL) at hospital discharge.DesignRetrospective, observational, propensity score (PS)-matched case-control study.SettingJapanese general hospitals.ParticipantsParticipants included 1,560 post-stroke patients hospitalized between 2006 and 2012 satisfying the following criteria: (1) data were available regarding age, sex, duration from stroke to hospital admission, length of stay, functional independence measure (FIM), modified Rankin scale (mRS) score, Glasgow coma scale (GCS) score, Japan Stroke Scale (JSS) score, and SEP participation; and (2) admitted ≤7 days after stroke onset, 7–60-day length of stay, pre-stroke mRS score ≤2, and not discharged due to FIM or mRS exacerbation. 780 PS-matched pairs were selected between SEP and no-SEP groups.Intervention. SEP participation.Main Outcome MeasuresAt discharge, FIM-motor, FIM-cognitive, FIM-motor gain (discharge value - admission value), FIM-motor gain rate (gain/length of stay), a binary variable divided by median FIM-motor gain rate (High Efficiency or no-High Efficiency), and mRS score.ResultsSubjects were classified into an SEP (n = 780) and a no-SEP group (n = 780). After matching, there were no significant between-groups differences except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of 0.71 with a 95% confidence interval of 0.68–0.73, and the model was believed to have a relatively favorable fit. Logistic regression analysis of PS-matched pairs suggested SEP was effective, with an overall odds ratio for ADL (High Efficiency or no-High Efficiency) of 2.2 (1.75–2.70).ConclusionsSEP may contribute to improving ADL.



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