| アブストラクト | INTRODUCTION: Early rehabilitation guidelines lack a consensus on the optimal early rehabilitation regimen; hence, the impact of rehabilitation timing and dose on stroke recovery outcomes remains unclear. Using Japanese medical claims data within a target trial emulation framework, this study evaluated the safety of early in-hospital rehabilitation after stroke. PATIENTS AND METHODS: This study analyzed patients aged >/= 18 years who were admitted to an acute hospital for acute stroke and received in-hospital rehabilitation within 2 days after admission, using the Japan Diagnosis Procedure Combination database (2018-2022). Rehabilitation exposures were defined as 6 predefined regimens (20-60 min/day initiated on days 1 or 2) and continued up to day 14. The outcome was the cumulative incidence of composite adverse events within 15 days after admission. A sequential, doubly robust estimator with a longitudinal modified treatment policy was applied, accounting for time-varying exposures and reducing potential time-related biases. RESULTS: Using a target trial emulation framework with doubly robust estimation, the incidence under the reference regimen was 11.2% (95% CI: 9.75%-12.60%). The highest incidence was 26.20% (95% CI: 24.30%-28.20%), corresponding to a risk ratio (RR) of 2.35 (95% CI: 2.03-2.72) compared with the reference. In contrast, several higher-intensity regimens were associated with lower incidences, with the lowest incidence of .49% (95% CI: .28%-.71%), yielding an RR of .04 (95% CI: .03-.07) versus the reference. However, intermediate-dose regimens showed variable associations across scenarios. DISCUSSION AND CONCLUSION: In this emulated trial, higher early rehabilitation doses were generally associated with a lower incidence of in-hospital adverse events. Regimens involving 60 min/day, particularly when initiated on day 1, showed the lowest estimated risk. However, the associations were not strictly linear, as intermediate-dose regimens demonstrated variable results across analyses. These findings suggest a potential benefit of adequately dosed early rehabilitation when clinically appropriate, while highlighting the importance of careful patient selection and monitoring. |
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| ジャーナル名 | Neurorehabilitation and neural repair |
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| Pubmed追加日 | 2026/7/27 |
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| 投稿者 | Tani, Takuaki; Cooray, Upul; Nishida, Daisuke; Fushimi, Kiyohide; Ikeda, Takaaki |
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| 組織名 | Department of Pharmacoepidemiology, Showa Medical University Graduate School of;Pharmacy, Tokyo, Japan.;Research Promotion Committee of the Japanese Society of Neurological Physical;Therapy, Tokyo, Japan.;University of Sydney School of Dentistry, NSW, Australia.;Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney,;NSW, Australia.;Department of Rehabilitation Medicine, Tokai University School of Medicine,;Isehara, Japan.;Institute of Science Tokyo Graduate School of Medical and Dental Sciences, Japan.;Department of Health Policy Science, Graduate School of Medical Science, Yamagata;University, Japan.;Department of International and Community Oral Health, Tohoku University Graduate;School of Dentistry, Sendai, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42504690/ |
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