title: Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of Japan rehabilitation database.
abstract: BACKGROUND
  Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties.
  
  
  METHODS
  Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination.
  
  
  RESULTS
  After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005).
  
  
  CONCLUSIONS
  Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke.
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Shoji
authors: S
authors: Kinoshita
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Wataru
authors: W
authors: Kakuda
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Ryo
authors: R
authors: Momosaki
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Naoki
authors: N
authors: Yamada
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Hidekazu
authors: H
authors: Sugawara
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors: Shu
authors: S
authors: Watanabe
authors: Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: abo@jikei.ac.jp.
authors: Masahiro
authors: M
authors: Abo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010810:Physical and Rehabilitation Medicine / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Board-certificated physiatrist; Functional Independence Measure; acute stroke; early rehabilitation; home discharge