Increased Frequency of Rehabilitation Sessions May Reduce Stroke Risk in Moderate RA

Senior man using walking frame in physiotherapy gym
Male physiotherapist supporting Malaysian patient in his 70s, learning to walk with frame
Researchers determined the effect of increased frequency of rehabilitation on stroke risk in patients with rheumatoid arthritis.

More than 40 rehabilitation sessions per year may reduce stroke risk in patients with moderate rheumatoid arthritis (RA) disease severity, according to study results published in PLoS ONE. Researchers also indicated that patients with RA with hypertension, diabetes, and moderate RA disease activity had increased risk for stroke.

To evaluate whether increased frequency of rehabilitation was protective against stroke, the study included patients with RA (n=16,244) from Taiwan’s National Health Insurance Research Database who had a catastrophic illness certificate between January 1, 2000, and December 31, 2006. Patients were followed up through December 31, 2013.

Before December 31, 2013, 663 (4.08%) patients developed a stroke. After matching for age, sex, and time interval between diagnosis of RA and stroke, researchers included 642 control participants without stroke before the end of 2013. Student’s t test and Chi-square tests were conducted to compare the clinical characteristics of patients with and without stroke. The odds ratio (OR) of stroke was determined by logistic regression analysis.

Results of the study showed that compared with patients without stroke, those with stroke had significantly increased prevalence of hypertension, diabetes, and hyperlipidemia; however, the number of rehabilitation sessions per year did not significantly differ between the groups of patients.

To study the effect of hypertension, diabetes, and hyperlipidemia on stroke, the researchers conducted logistic regression analysis. Results indicated that patients with RA with hypertension had a 2.10 OR of stroke and patients with diabetes had a 1.91 OR (both P <.001); however, patients with RA with hyperlipidemia did not have a higher risk for stroke (OR, 1.29; P =.144). Furthermore, compared with patients with mild RA disease severity, patients with moderate RA severity had an increased risk for stroke (OR, 1.37; P =.034).

Initially, patients who received more rehabilitation sessions did not have a significantly reduced risk for stroke (OR, 0.66; P =.061); however, after stratifying for effect of rehabilitation frequencies by disease severity, researchers found that more rehabilitation sessions were linked to a reduced risk for stroke in patients with moderate RA disease severity (OR, 0.32; P =.039).

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Study limitations included the unavailability of certain risk factors, determination of disease severity using medications prescribed rather than a validated disease severity index, and the number of rehabilitation sessions not accurately reflecting activity levels.

“[Physical] activities brought by more rehabilitation sessions were shown to be beneficial and should be encouraged in patients [with RA] with high disease severity without the protection of biologic agents,” the researchers concluded. They also noted that further prospective studies will be needed to confirm their findings from this study.


Cheng Y-Y, Chang S-T, Kao C-L, Chen Y-H, Lin CH. The impact of rehabilitation frequency on the risk of stroke in patients with rheumatoid arthritis [published online January 13, 2020]. PLoS ONE. doi:10.1371/journal.pone.0227514

This article originally appeared on Rheumatology Advisor