Unmet challenges for rehabilitation after stroke in China

Stroke is an important public health problem in China, and is one of the leading causes of death and disability. About 2 500 000 people have a stroke in China every year, and 70–80% of patients lose the ability to perform routine activities and require care, resulting in an economic burden for both the country and their family.1Chinese Expert Committee on Rehabilitation after Acute Ischemic StrokeExpert panel consensus recommendations for the management of rehabilitation after acute ischemic stroke in China.Chin J Phys Med Rehabil. 2016; 38 (in Chinese).: 1-6Google Scholar Japan has a similar incidence of stroke because of similar ancestry, but outcomes after stroke are better in Japan than in China. In Japan, 64·2% of young patients (age <65 years) and 42·2% of elderly patients (age ≥65 years) achieve independent walking, and 60·2% of young patients and 52·8% of elderly patients return to community life.2The Japan Stroke SocietyGuidelines for rehabilitation in the acute phase after stroke.in: The Japan Stroke Society Japanese Guidelines for the Management of Stroke 2015. Kyowa Kikaku, Tokyo2015: 2-3Google Scholar Japan has a good medical insurance system and a thorough rehabilitation system and, therefore, most Japanese patients have a high chance of receiving early, appropriate rehabilitation, which explains the difference in recovery between Japanese and Chinese patients who have a stroke. Although there is strong demand for patients to receive rehabilitation services, early rehabilitation in China is unsatisfactory for a number of reasons. First, the medical insurance system in China does not fully cover stroke rehabilitation, and nursing care insurance is unavailable. Second, a stereoscopic rehabilitation system, including hospitals, communities, insurance, and nursing services, is not well established in China. Junior doctors often do not want to work in rehabilitation because of the low income in this field. The number of well trained therapists, especially speech therapists, and caregivers is insufficient. There is also no training or licensing system for caregivers in China. Most caregivers are women from rural areas who have low levels of education. Third, the rehabilitation technologies in China are less developed than those in Japan and many rehabilitation devices (such as simulated kitchen, baths, and toilets equipped for activities of daily living training) are not available in China. The importance of early rehabilitation is not commonly known by the general population in China. It was reported that only 38·9% of patients and their family members knew the importance of rehabilitation after stroke.3Zhang X Chen Y Liu Y Gu W Wang C Bi Z Survey of the cognition and requirements of the community stroke rehabilitation.Shanghai Med Pharm J. 2015; 18 (in Chinese).: 58-60Google Scholar Moreover, only 11·5% of patients underwent rehabilitation within 1 week of a stroke4Huang X Zhang M Shi Y Wang X Situation analysis of the early rehabilitation after stroke in a Chinese cohort.Chin Heal Standard Management. 2015; 20 (in Chinese).: 31-33Google Scholar and 42·4% of patients did not undergo any rehabilitation after stroke in China.5Zhu X Yin A The status of community rehabilitation and rehabilitative measures after stroke in China.Med J Chin Peoples Health. 2010; 20 (in Chinese).: 60-61Google Scholar The difference in rehabilitation systems between China and Japan (appendix) is associated with the notable differences in clinical outcome. The Chinese Government should design policies to address these issues, improve the insurance system, train rehabilitation therapists, and provide health education for the general population. The experience and technological advances of rehabilitation in Japan could be useful in informing stroke treatment in China. We declare no competing interests. Download .pdf (.12 MB) Help with pdf files Supplementary appendix