Table 1_Interaction effect of rehabilitation initiation timing and hospitalization frequency on long-term functional outcomes after stroke in rural China: a retrospective cohort study.docx

ObjectiveTo investigate the effects of rehabilitation-initiation timing (RIT) and rehabilitation-hospitalization frequency (RHF) on activities of daily living (ADL) evaluated at 6 months post-stroke.
DesignRetrospective cohort study.
SettingConvalescent rehabilitation wards in urban and suburban areas of Xiangyang, China.
ParticipantsA total of 275 patients with ADL impairment following acute or subacute stroke who received inpatient comprehensive rehabilitation between 2021 and 2024.
InterventionsParticipants underwent inpatient multidisciplinary rehabilitation—including physical therapy, occupational therapy, and individualized functional exercises—during each hospitalization, with each inpatient rehabilitation episode lasting for 3 weeks. The main exposures were the timing of rehabilitation initiation and the total number of inpatient rehabilitation episodes within the first 6 months post-stroke.
Main outcome measuresThe primary outcome was the change in ADL, assessed by the Barthel Index (BI), from baseline to the 6-month post-stroke follow-up.
ResultsAt the 6-month (180-day) follow-up, the mean BI score increased by 12.59 points compared to baseline (95% CI, 5.53–19.65; p < 0.001). Compared to those who started rehabilitation at 61–90 days post-stroke, patients who initiated rehabilitation earlier—at 1–14, 15–30, and 31–60 days—showed greater BI improvements at 6 months, with mean differences of 15.48 (95% CI, 4.90–26.06; p = 0.004), 13.18 (95% CI, 3.85–22.51, p = 0.005), and 8.63 (95% CI, 0.40–16.86, p = 0.04) points, respectively. Among patients who started rehabilitation at 1–14 and 15–30 days, each additional systematic inpatient rehabilitation was associated with a further mean BI increase of 2.24 (95% CI, 0.98–5.46, p = 0.20) and 2.10 (95% CI, 0.87–5.07, p = 0.21) points, respectively, although these differences did not reach statistical significance. Subgroup analysis showed that early rehabilitation significantly improved BI in patients aged ≥65 and those with hemorrhagic stroke. Moreover, higher hospitalization frequency benefited patients with higher education and those with hemorrhagic stroke.
ConclusionEarlier initiation and greater frequency of inpatient rehabilitation were independently associated with better ADL outcomes at the 6-month mark in rural Chinese stroke survivors. Importantly, the benefit of each additional rehabilitation admission was amplified when therapy began within the first month post-stroke and diminished when initiation was delayed beyond two months, especially among patients with hemorrhagic stroke, aged ≥65 years, women, and those with higher educational attainment.