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

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; 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.