Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

ABSTRACT: Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive physical, occupational, and speech therapy in PAC facility. However, few studies have evaluated the effects of PAC in poststroke patients since PAC's initiation in Taiwan. Thus, this study aims to investigate whether the length of stay in a PAC institution correlates with patients' improvements.This retrospective and single-center study in Taiwan enrolled 193 poststroke patients who had received acute care at Chi-Mei Medical Center, Taiwan, at any period between 2014 and 2017. Data on their length of stay in the PAC institution were collected. Poststroke patients' functional ability-such as activities of daily living (ADL) function and swallowing ability-as well as their corresponding scales were assessed on the first and last day of PAC stay. Statistical analysis was conducted by SPSS version 21.0 .The average duration of PAC stay was 35.01 ±â€Š16.373 days. Duration of PAC stay was significantly positively correlated with the Barthel index (P < .001), Berg balance test score (P < .001), gait speed (P = .002), and upper sensory function and upper motor function within the Fugl-Meyer Assessment (both P < .001).Poststroke patients with longer stay in a PAC institution had superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function.

Comparison of Cost-Effectiveness between Inpatient and Home-Based Post-Acute Care Models for Stroke Rehabilitation in Taiwan.

Stroke rehabilitation focuses on alleviating post-stroke disability. Post-acute care (PAC) offers an intensive rehabilitative program as transitional care following acute stroke. A novel home-based PAC program has been initiated in Taiwan since 2019. Our study aimed to compare the current inpatient PAC model with a novel home-based PAC model in cost-effectiveness and functional recovery for stroke patients in Taiwan. One hundred ninety-seven stroke patients eligible for the PAC program were divided into two different health interventional groups. One received rehabilitation during hospitalization, and the other received rehabilitation by therapists at home. To evaluate the health economics, we assessed the total medical expenditure on rehabilitation using the health system of Taiwan national health insurance and performed cost-effectiveness analyses using improvements of daily activity in stroke patients based on the Barthel index (BI). Total rehabilitative duration and functional recovery were also documented. The total rehabilitative cost was cheaper in the home-based PAC group (p < 0.001), and the cost-effectiveness is USD 152.474 ± USD 164.661 in the inpatient group, and USD 48.184 ± USD 35.018 in the home group (p < 0.001). Lesser rehabilitative hours per 1-point increase of BI score was noted in the home-PAC group with similar improvements in daily activities, life quality and nutrition in both groups. Home-based PAC is more cost-effective than inpatient PAC for stroke rehabilitation.

Cerebral Oxygenation during Exercise in Patients with Cardiopulmonary Diseases: A Prospective Observational Study.

BACKGROUND: The relationship between exercise and cerebral oxygenation has gained increasing attention. However, few studies have investigated the correlation between exercise and cerebral oxygenation in patients with cardiopulmonary diseases. OBJECTIVES: To investigate the correlation between exercise and cerebral oxygenation in patients with cardiopulmonary diseases. METHODS: Thirty eligible patients with cardiopulmonary diseases underwent incremental cardiopulmonary exercising test (CPET) and near-infrared spectroscopy with both right and left sensors placed at the mid forehead to detect oxygen saturation of cerebral tissue (STO2). Parameters of cerebral oxygenation and exercise intensity were collected and analyzed. RESULTS: The average age of the patients was 51.17 ± 10.21 years and included 23 males and 7 females. The average maximal STO2 of the left and right brain during CPET were 51.850 ± 1.57% and 51.755 ± 1.90%, respectively. Meanwhile, mean oxygen consumption (VO2) while reaching maximal STO2 was 4.42 ± 1.05 metabolic equivalents (METs) over the left brain and 4.34 ± 1.17 METs over the right brain. The exercise intensity upon reaching maximal STO2 was 84.91 ± 11.70% over the left brain and 83.16 ± 14.64% over the right brain. Peak VO2 was significantly correlated to VO2 upon reaching maximal STO2 over the left and right brain (R = 0.805, p < 0.001 and R = 0.739, p < 0.001, respectively). Age was significantly negatively correlated to VO2 upon maximal STO2 over the left and right brain (R = -0.378, p = 0.039 and R = -0.513, p = 0.004, respectively). CONCLUSIONS: Cerebral oxygenation increases with higher exercise intensity, and it reaches a maximal STO2 between respiratory compensation point and peak exercise. The higher the peak VO2, the better the VO2 upon reaching maximal STO2.