Clinical Effectiveness of Board-certificated Physiatrists on Functional Recovery in Elderly Stroke Patients During Convalescence: A Retrospective Cohort Study

Abstract

Background: Rehabilitation is an important determinant of functional recovery in elderly stroke patients. The purpose of this study was to clarify the clinical effectiveness of board-certificated physiatrists as responsible physicians on functional recovery in elderly stroke patients during convalescence. Methods: In this retrospective study, we analyzed the data of post-stroke patients admitted to rehabilitation wards entered into the Japan Rehabilitation Database between 2005 and 2013. The main outcome was Functional Independence Measure efficiency. For analysis, we used propensity scores and inverse probability weighting adjustment to reduce selection bias. A generalized estimation equation was used to account for confounding by cluster. Results: A total of 2873 patients (mean age: 70) were eligible after applying exclusion criteria. The responsible physicians caring for 1214 stroke patients were board-certificated physiatrists. Using inverse propensity score weighting, patients' baseline characteristics were closely balanced between patients who were managed by board-certificated physiatrists and those without board-certificated physiatrists. After adjustment, patients who were managed by a board-certificated physiatrist as a responsible physician had significantly higher scores for Functional Independence Measure efficiency than those without a board-certificated physiatrist (mean: 0.31 vs 0.28; p = 0.035). Conclusions: Our results suggest that clinical management provided to elderly stroke patients by board-certificated physiatrists is associated with good functional improvement. Board certification should be encouraged to improve the quality of rehabilitative management of post-stroke patients.

Keywords

• activities of daily living
• convalescence
• elderly
• physical rehabilitation
• stroke