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Updated: May 20, 2026
Computerized Adaptive Testing System of Functional Assessment of Stroke
Published on: January 7, 2019
The Impact of Taiwan's Nationwide Postacute Care Program on Functional Recovery, Health Care Utilization, and
Chao-Chun Huang1, Fu An Yang2, Yi-Ching Chu3
1Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei City; Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei.
Objective:
To synthesize and meta-analyze the clinical and economic impacts of Taiwan's nationwide Post-Acute Care for Cerebrovascular Disease (PAC-CVD) program regarding functional recovery, health care utilization, and cost-effectiveness within a single-payer system.
Data Sources:
PubMed, Embase, Scopus, Cochrane Library, and Airiti Library were searched from March 2014 through August 2025 using MeSH and keywords (Stroke, Postacute care).
Study Selection:
Quantitative observational cohorts and economic evaluations of the PAC-CVD program, including single-group pre-post studies and quasi-experimental designs comparing PAC with traditional care using propensity score matching.
Data Extraction:
Two independent reviewers extracted data on functional scores (Barthel Index [BI], Berg Balance Scale [BBS]), disability (modified Rankin Scale [mRS]), readmissions, and costs. Quality was assessed via the Newcastle-Ottawa Scale.
Data Synthesis:
Thirty-three studies involving >10,000 stroke survivors were included. Meta-analysis showed substantial gains: pooled BI improvement was +25.4 (95% confidence interval [CI]: 23.3-27.5) and BBS +16.3 (95% CI: 14.6-18.0). The mRS change was -0.71 (95% CI: -0.74 to -0.68). Compared with traditional care, PAC demonstrated superior recovery (mean difference in BI change: +9.5, 95% CI: 3.8-15.2), significantly lower 30-day readmissions, and nearly 50% reduction in acute care costs ($5,848 vs $11,061). Subgroup analyses revealed high heterogeneity (I2=70.4%) in BI gains, influenced by stroke severity, and age. Grading of Recommendations, Assessment, Development, and Evaluations certainty was moderate for disability reduction (mRS) but low for functional gains because of heterogeneity.
Conclusions:
The nationwide PAC-CVD program is associated with significantly enhanced functional independence and offers a cost-effective alternative to traditional rehabilitation. Although promising, attenuated gains in older and severely disabled subgroups suggest a need for personalized "PAC-Plus" strategies integrating comprehensive geriatric assessment and intervention. This model serves as a scalable template for aging societies seeking to bridge the gap between acute and long-term care systems worldwide.