Quality Management Program of Stroke Rehabilitation Using Adherence to Guidelines: A Nationwide Initiative in Japan

J Stroke Cerebrovasc Dis. 2019 Sep;28(9):2434-2441. doi: 10.1016/j.jstrokecerebrovasdis.2019.06.028. Epub 2019 Jul 10.


Background and aim: In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue.

Methods: We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel.

Results: The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators).

Conclusion: This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.

Keywords: Stroke Rehabilitation; evidence-based practice; healthcare; quality indicator.

Publication types

  • Review

MeSH terms

  • Disability Evaluation
  • Guideline Adherence / standards*
  • Health Care Surveys
  • Health Status
  • Humans
  • Japan / epidemiology
  • Outcome and Process Assessment, Health Care / standards*
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Quality Improvement / standards*
  • Quality Indicators, Health Care / standards*
  • Recovery of Function
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / physiopathology
  • Stroke / therapy*
  • Stroke Rehabilitation / standards*
  • Treatment Outcome