Status of Rehabilitation After Ischemic Stroke: A Korean Nationwide Study

Objective To investigate the post-stroke rehabilitation status according to stroke severity using the database of the Korean Health Insurance Review and Assessment Service. Methods The data of patients admitted to the neurology departments of 12 hospitals within 7 days of onset of ischemic stroke were collected. A total of 2,895 patients hospitalized between November 2010 and December 2011 were included. The patients were classified into three groups according to their initial National Institutes of Health Stroke Scale (NIHSS) scores (mild, ≤5; moderate, >5 and ≤13; and severe, >13). Length of hospital stay (LoS) with rehabilitation, NIHSS score after acute care, and scores on modified Rankin Scale (mRS) were examined at 1 year post-stroke according to stroke severity and ongoing rehabilitation. Results The total LoS for ongoing rehabilitation significantly increased with stroke severity (mild, 91.66±149.70; moderate, 197.26±241.93; severe, 263.50±275.75 days; p<0.01). However, the proportion of LoS with ongoing rehabilitation to the total LoS tended to decline with increasing stroke severity (mild, 77.93±29.50, p<0.01; moderate, 71.83±32.13; severe, 62.29±37.19). The home discharge rate of the group that underwent continuous inpatient rehabilitation was significantly higher in patients with moderate and severe stroke, respectively (14.2% vs. 0.0%, p<0.001; 7.4% vs. 0.0%, p=0.032). Conclusion This study showed that intermittent rehabilitation was often provided after acute care, whereas ongoing rehabilitation positively affected rate of home discharge in patients with moderate and severe stroke in Korea. These results represent evidence for improving the healthcare system to promote adequate rehabilitation in the future.