Association Between the Volume of Inpatient Rehabilitation Therapy and the Risk of All-Cause and Cardiovascular Mortality in Patients With Ischemic Stroke

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. Design: A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009. Setting: Referral medical center. Participants: Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital. Interventions: Not applicable. Main Outcome Measure: 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. (C) 2014 by the American Congress of Rehabilitation Medicine