Purpose: Clinical studies suggest that early rehabilitation can accelerate the healing process of brain cells after a cerebral vascular accident (CVA), but there still lacks empirical evidence to support the claim. The current research will examine the effects of early rehabilitation on treatment outcome and medical cost for CVA patients.
Method: Data from Taiwan National Health Insurance (NHI) database during 2003-2006 was used in this retrospective study, drawing 16,361 CVA subjects. Subjects were divided into four categories depending on when they start rehabilitation: 1) immediately; 2) 7 days after discharge; 3) 7-31 days after discharge; and 4) exceeding 31 days after discharge. Logistic regression was used to analyse patient mortality rate and comorbidity rate to examine the outcomes, and linear regression was used to analyse total medical cost, rehabilitation cost A (physical and occupational therapy costs) and rehabilitation cost B (swallowing therapy). Control variables include sex, age, presence of cardiovascular disease, high blood pressure, diabetes, frequency of rehabilitation within six months after discharge.
Result: Results showed that patients who receive rehabilitation more than 31 days after discharge had mortality rate 1.7 times higher than patients who started rehabilitation immediately, and their comorbidity rates for bed sores, urinary infections, deep vein thrombosis and pneumonia were also 1.75-2.32 times higher. As for medical cost, patients who received rehabilitation after discharge were 1.17-1.75 times higher on total medical cost and rehabilitation cost A than those receiving rehabilitation during hospitalization. Patients who received rehabilitation 7 days after discharge was 1.75 times higher than patients who rehabilitated during hospitalization on rehabilitation cost B.
Conclusion: Results indicated that early rehabilitation could reduce mortality and comorbidity rate of CVA patients as well as the medical cost. According to previous studies, medical personnel need to focus on stabilizing the condition and physical functions for acute CVA, and improving the patients overall abilities and functions once their physical and psychological states are revived. Comprehensive assessments should be provided while patients are hospitalized, and offer appropriate rehabilitation, condition tracking, and managing plans in order to effectively minimize long-term damages for the patients and medical cost.
Candidate for the Lee B. Lusted Student Prize Competition