国家神经系统疾病临床医学研究中心数据管理与共享系统

发表杂志：Neurol Res

发表类型: Research Article

影响因子(IF): 1.9

PMID: 36126147 Pubmed原文链接 全文下载

Stroke is the second most common cause of death  and major cause of disability globally.in China Stroke affects more than 2.5 million people each year. Among stroke survivors, 70-80% are can not live independently because of disability . Consequently, optimal restoration of functional independence is an essential goal of stroke management. Evidence-based medicine confirms that stroke rehabilitation is the most effective way to reduce disability.and the importance of early functional assessment in optimizing recovery. In guidelines from across the world, it is recommended that all patients receive a standardized rehabilitation assessment to determine the type and duration of rehabilitation needed prior to discharge. Intracerebral hemorrhage (ICH) is a devastating subtype of stroke, About half of patients survive intracerebral hemorrhage (ICH), but most are left with significant disability.Rehabilitation after ICH is the mainstay of treatment to reduce impairment, improve independence in activities, and return patients to meaningful participation in the community.However, in china about 59.4% patients with acute ischemic Stroke were assessed for rehabilitation in 2012-2013 . This results compare unfavourably with in the United Kingdom and the United States of America where 89% and 90% of patients, respectively, received documented rehabilitation assessments. But,there is little data on current practice in China on the assessment and provision of rehabilitation for ICH patients during hospitalization.So we used data from the China Stroke Center Alliance to examine the describe current practice and investigate factors associated with assessment for rehabilitation following intracerebral hemorrhage。

The implementation and analysis of the study is based on CSCA. The CSCA is a national, hospital-based, multicentre, voluntary, multifaceted intervention and continuous QI initiative. Patients were recruited consecutively in all 1476 hospitals from August 2015 to July 2017, who met the following criteria: (1) are aged 18 years or older; (2) have a primary diagnosis of  intracerebral haemorrhage ;(3) are within 7 days of symptom onset; (4) are admitted either directly to wards or through the emergency department . Patients with cerebral venous sinus thrombosis or non-cerebrovascular diseases were excluded. The proportion of patients who received assessment of rehabilitation was described at the patient level. The adherent rate of rehabilitation assessment at the hospital level was defined as the total number of eligible patients receiving rehabilitation assessment divided by the total number of eligible patients of each hospital. Baseline patient-level characteristics were compared for patients with and without a rehabilitation assessment and hospital-level features were compared for hospitals above and below the median rate of assessment by using Pearson chi-square tests for categorical variables and Mann-Whitney U test for continuous variables. A multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was performed to identify patient and hospital characteristics independently associated with rehabilitation assessment. All tests are two-tailed with p < 0.05 to be considered as the level of statistical significance. All analyses were performed by using SAS Version 9.3 software.