Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching.

Few studies have compared how rehabilitative post-acute care affects recovery of walking ability and other functions after stroke in different age groups. After propensity score matching (1:1), 316 stroke patients were separated into an aged group (age ≥65 years, n=158) and a non-aged group (age <65 years, n=158). Both groups significantly improved in Barthel index, EuroQol-5 dimension, Berg balance scale, 6-minute walking distance and 5-meter walking speed (P<0.001). The non-aged group had significantly larger improvements in Berg balance scale, instrumental activities of daily living, EuroQol-5 dimension and 6-minute walking distance (P<0.001) compared to the aged group. The two groups did not significantly differ in Barthel index, 5-meter walking speed, length of stay, and cost. The aged group had poorer walking ability and poorer instrumental activities of daily living compared to the non-aged group. After intensive rehabilitative post-acute care, however, the aged group improved in walking ability, functional performance and mental health. Intensive strength training for unaffected lower limbs in the stroke patients achieved good recovery of walking ability and other functions. Overall, intensive rehabilitative post-acute care improved self-care ability and decreased informal care costs. Rehabilitative PAC under per-diem reimbursement is efficient and economical for stroke patients in an aging society.

[A case of Guillain-Barré syndrome with elevated IgG anticardiolipin antibody titer with recurrent deep venous thromboses].

We report a 76-year-old woman with Guillain-Barré syndrome (GBS) who developed recurrent deep venous thromboses (DVT). She has had no past medical history of thromboembolic events or fetal loss. Because D-dimer was elevated from the early stage of her illness, heparin, and then warfarin, was given as prophylaxis for thromboembolic events. On Day 103, she developed marked edema in her legs, and DVT was diagnosed in the left popliteal vein by ultrasound. Three days later, the patient developed pulmonary embolism, and an inferior vena cava filter was implanted. Although D-dimer became temporarily normal, it increased again, and recurrent DVT was diagnosed in bilateral femoral veins on Day 167. IgG anticardiolipin antibody titer was found to be highly elevated at 79 U/ml (normal range: < 10). However, anti-beta 2 glycoprotein I antibody, which has been proven to be associated with antiphospholipid syndrome (APS), was negative. Thus, IgG anticardiolipin may have played an important role in the thromboembolic events in this patient. We speculate that the occurrence of APS may be associated with anticardiolipin antibody, which may form in some patients with GBS secondary to myelin damage.

Changes in stroke rehabilitation outcomes after the implementation of Japan's long-term care insurance system: a hospital-based study.

OBJECTIVE: To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system. DESIGN: Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge. RESULTS: A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups. CONCLUSIONS: Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.