title: Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.
abstract: Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.
authors.affiliation: 1 Duke Clinical Research Institute, Duke University, Durham, NC, USA.|2 Duke Global Health Institute, Durham, NC, USA.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: 3 Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|4 China National Clinical Research Center for Neurological Diseases, Beijing, China.
authors.forename: Zixiao
authors.initials: Z
authors.lastname: Li
authors.affiliation: 1 Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: 4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|5 Neuro-Intensive Care Unit, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: 3 Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|4 China National Clinical Research Center for Neurological Diseases, Beijing, China.
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: 4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: 7 Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|8 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.affiliation: 4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunjuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: 4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: 6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|9 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Anxin
authors.initials: A
authors.lastname: Wang
authors.affiliation: 6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|9 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: 1 Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: 4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: 3 Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.|4 China National Clinical Research Center for Neurological Diseases, Beijing, China.|6 Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000534:rehabilitation / Q000628:therapy*; D002681:China; D005260:Female; D006760:Hospitalization; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation
keywords: Acute stroke; evidence-based practice; rehabilitation; stroke care