Evidence-practice Gaps And Structures Associated With Practice In Stroke Rehabilitation: Claims Database Study In Japan

Research Objectives: To investigate evidence-practice gaps in the rehabilitation of patients with stroke.

Design: A retrospective cohort study among 9 years

Setting: Medical practitioners' receipt for health insurance claim (Shizuoka Kokuho Database in Japan)

Participants: The subjects included 142,457 patients (47.2% male, 74.7±10.3 years old) who were selected from 537,003 patients with a diagnosis of stroke (cerebral hemorrhage, cerebral infarction, subarachnoid hemorrhage) between April 2012 and September 2020. Moreover, patients who had passed one year since the start of the observation period were also included. Patients who with suspected disease and who died within three days from the onset date were excluded.

Interventions: Not applicable.

Main Outcome Measures: Evidence-practice gap is measured based on the percentage of rehabilitation performed in the same month of or within 7 days from onset. Furthermore, the number of units of post-onset rehabilitation and structural factors related to the number of units (e.g., number of rehabilitation physicians, number of physical therapists, number of occupational therapists, number of hospital beds) were analyzed.

Results: Rehabilitation was performed in 25.4% of cases, and the percentage varied by region. Factors that were mainly related to the number of units included age, number of rehabilitation physicians, and number of physical therapists.

Conclusions: Although interpreted differently depending on stroke severity and medical resources, post-stroke rehabilitation is performed in approximately one fourth of the cases, which is not very common.

Author(s) Disclosures: All authors declare no conflicts of this study.