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Post-acute care for stroke – a retrospective cohort study in Taiwan

Authors Lai CL, Tsai MM, Luo JY, Liao WC, Hsu PS, Chen HY

Received 3 March 2017

Accepted for publication 16 May 2017

Published 1 August 2017 Volume 2017:11 Pages 1309—1315

DOI https://doi.org/10.2147/PPA.S136041

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Chung-Liang Lai,1,* Ming-Miau Tsai,1,* Jia-Yuan Luo,1 Wan-Chun Liao,1 Pi-Shan Hsu,2,3 Han-Yu Chen4

1Department of Physical Medicine and Rehabilitation, 2Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, 3Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, 4Department of Physical Therapy, Hungkuang University, Taichung, Taiwan

*These authors contributed equally to this work

Background: Stroke often causes functional decline in patients. Therefore, after the acute phase, many patients require post-acute care (PAC) to maximize their functional progress, reduce disability, and make it possible for them to return to their home and community. PAC can be provided in different settings. Taiwan’s National Health Insurance (NHI) proposed a PAC pilot program, effective since 2014, for stroke patients that allowed patients with the potential for functional improvement to receive PAC rehabilitation in regional or community hospitals. The purpose of this study was to explore the initial achievements and clinical impact of this program in Taiwan.
Methods: This was a retrospective cohort study that mainly analyzed basic hospitalization data and scores for function and quality of life, as recorded immediately after admission and before discharge, for stroke patients in the PAC program in a hospital in Taiwan.
Results: This study collected complete data from a total of 168 patients. After an average of 43.57 days in the program, patients showed significant improvement in the Modified Rankin Scale (MRS), the Barthel Activity Daily Living Index (B-ADL), the Lawton–Brody Instrumental Activity Daily Living Scale (LB-IADL), the Functional Oral Intake Scale (FOIS), and the Mini Nutrition Assessment (MNA), in mobility, self-care, and usual activity, as well as on anxiety/depression in the EuroQol Five Dimensions Questionnaire (EQ-5D) and in the Mini Mental State Examination (MMSE). After discharge, 76.8% of the patients could return to their home and community.
Conclusion: This study showed that the pilot PAC program significantly promoted recovery of function in stroke patients and helped them to return to their home and community. Patients with the potential for functional recovery should consider receiving PAC service in a hospital after discharge from acute stroke care.

Keywords: post-acute care, rehabilitation, stroke

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