How large is the gap between China and Japan in the area of stroke rehabilitation?

October 13, 2018

Original author: Rehabilitation Society

“Cerebral apoplexy” is also known as “stroke” and “cerebrovascular accident”. It is an acute cerebrovascular disease. It is a group of diseases, including ischemic and hemorrhagic stroke, that cause brain tissue damage due to sudden rupture of cerebral blood vessels or blockage of blood vessels leading to the inability of blood to flow into the brain, including ischemic and hemorrhagic strokes, which are more common in the elderly.

According to the data of the National Bureau of Statistics, by the end of 2016, the elderly population over 60 years old in China has reached 220 million, accounting for 16.7% of the total population, which is one fifth of the total elderly population in the world and one twelve of the total population in Asia. Of these elderly people, 70 million need rehabilitation and care.

In the Lancet magazine published on July 8, 2017, Dr. Takeshi Asakawa, a well-known neurologist, published an article pointing out the huge gap in post-stroke rehabilitation between China and Japan.

The difference of stroke incidence between China and Japan is small. The recovery rate of prognosis in Japan is much higher than that in China.

With the aging of China’s population, stroke, with a high disability rate, is increasingly becoming an important public health problem. There are 2.5 million new cases in China every year, and about 70-80% of the patients lose the ability to take care of themselves, which brings huge burden to the families of patients and consumes a lot of social resources.

Japanese and Chinese people belong to the same yellow race. The incidence of stroke is similar to that of China. However, the prognosis of Japanese stroke patients is significantly better than that of China. According to the Japanese Stroke Guidelines, 64.2% of the younger stroke patients under 65 years old and 42.2% of the older stroke patients over 65 years old can recover the ability to walk independently in Japan, while 60.2% of the younger stroke patients and 52.8% of the older stroke patients can return to the community to enjoy ordinary life.

Factors Causing the Rehabilitation Gap between China and Japan

Asakawa also believes that Japan’s relatively perfect medical insurance system and excellent stroke rehabilitation system enable stroke patients to receive reasonable and timely rehabilitation treatment at an early stage, which is an important reason for such a disparity in prognosis.

Despite the huge demand for rehabilitation services, for a variety of reasons, early rehabilitation in China has not been satisfactory.

The Gap in Rehabilitation System between China and Japan

Firstly, China’s medical insurance does not cover the whole process of rehabilitation as Japan does, nor does it set up care insurance for the elderly as Japan does.

Second, China has not yet established an efficient and three-dimensional rehabilitation system including community, rehabilitation hospital, insurance and nursing services. Rehabilitation physicians in China are poorly paid compared with other specialists, resulting in young medical college graduates unwilling to engage in rehabilitation, while strictly trained rehabilitation therapists, especially ST rehabilitation physicians, are far from meeting their needs. China does not have access system for nursing workers as Japan does. Many nursing workers in China come from middle-aged and elderly women with low education in rural areas.

Third, there is still a big gap between China’s rehabilitation equipment and Japan’s. Many common devices in Japan, such as OT simulation life scene training equipment, simulation kitchen and so on, are not found in dozens of rehabilitation hospitals or general hospitals at different levels in different regions of China.

Japanese Simulated Life Scene Training Equipment

Rehabilitation training

In addition, the general public still has a low awareness of the importance of early rehabilitation. A study showed that only 38.9% of the population knew the importance of stroke rehabilitation. Moreover, only 11.5% of the patients received rehabilitation treatment within one week of stroke, and 42.4% of the patients did not receive any rehabilitation treatment after stroke.

To sum up, the difference between the rehabilitation systems of China and Japan results in a great difference in the prognosis of patients. Now is the time for the government to take measures to improve this situation. Specific measures should include improving the rehabilitation system, training more rehabilitation talents, and strengthening health education for the general public. As the same race of Japan, its rehabilitation experience and technology are worthy of attention and application.

As a Chinese scientist, Professor Shakawa is also willing to work with people of insight from all walks of life to bring Japan’s advanced rehabilitation concepts and technologies to China to improve the level of rehabilitation services and truly benefit stroke patients.

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