title: Association between the volume of inpatient rehabilitation therapy and the risk of all-cause and cardiovascular mortality in patients with ischemic stroke.
abstract: OBJECTIVE
  To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity.
  
  
  METHODS
  A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009.
  
  
  METHODS
  Referral medical center.
  
  
  METHODS
  Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Stroke-related mortality.
  
  
  RESULTS
  During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend <.001 for both). Compared with the first tertile, the third tertile of rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30-.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31-.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively).
  
  
  CONCLUSIONS
  The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted.
authors.affiliation: Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Gwo-Chi
authors.initials: GC
authors.lastname: Hu
authors.affiliation: Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Rehabilitation Medicine, Ten-Chan General Hospital, Taoyuan, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Kung
authors.initials: HK
authors.lastname: Yu
authors.affiliation: Department of Rehabilitation Medicine, Mackay Memorial Hospital, Hsinchu, Taiwan.
authors.forename: Jiann-Perng
authors.initials: JP
authors.lastname: Chen
authors.affiliation: Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: kung527@yahoo.com.tw.
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000534:rehabilitation*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation
keywords: CI; Cardiovascular disease; Cerebral infarction; HR; Mortality; NIHSS; National Institutes of Health Stroke Scale; Rehabilitation; Treatment outcome; confidence interval; hazard ratio