title: Effects of a Self-Exercise Program on Activities of Daily Living in Patients After Acute Stroke: A Propensity Score Analysis Based on the Japan Association of Rehabilitation Database.
abstract: To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge.
  
  
  
  Retrospective, observational, propensity score (PS)-matched case-control study.
  
  
  
  General hospitals.
  
  
  
  Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no-self-exercise program groups.
  
  
  
  Self-exercise program participation.
  
  
  
  At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value - admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no-high efficiency), and mRS score.
  
  
  
  Patients were classified into a self-exercise program (n=780) or a no-self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no-high efficiency) of 2.2 (95% confidence ratio, 1.75-2.70).
  
  
  
  SEPs may contribute to improving ADL.
authors.affiliation: Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Handa-city, Aichi, Japan. Electronic address: n-shira@n-fukushi.ac.jp.
authors.forename: Nariaki
authors.initials: N
authors.lastname: Shiraishi
authors.affiliation: Department of Comprehensive Community Care Systems, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Physical Therapy, Faculty of Health Science, Kio University, Koryo, Nara, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.affiliation: Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Jeong
authors.affiliation: Department of Rehabilitation, Chubu Rosai Hospital, Nagoya, Aichi, Japan.
authors.forename: Motoya
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu City, Aichi, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba-shi, Chiba, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Kondo
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007564:Japan; D008297:Male; D026741:Physical Therapy Modalities; D057216:Propensity Score; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D012737:Sex Factors; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Activities of daily living; Propensity score; Rehabilitation; Stroke