Abstract
OBJECTIVE: To 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. DESIGN: Retrospective cohort study. SETTING: Convalescent rehabilitation wards in urban and suburban areas of Xiangyang, China. PARTICIPANTS: A total of 275 patients with ADL impairment following acute or subacute stroke who received inpatient comprehensive rehabilitation between 2021 and 2024. INTERVENTIONS: Participants 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 MEASURES: The primary outcome was the change in ADL, assessed by the Barthel Index (BI), from baseline to the 6-month post-stroke follow-up. RESULTS: At 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. CONCLUSION: Earlier 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.